Detection Of Metastatic Lesions Research Articles

Ultrasonographic liver nodules are more often benign lesions in dogs with hemoperitoneum secondary to splenic tumor rupture.

To evaluate the reliability of preoperative abdominal ultrasonography as a staging tool for dogs with hemoperitoneum due to presumed splenic tumor rupture, focusing on the detection of metastatic lesions in the liver. 99 dogs from 20 emergency and specialty hospitals across the US. Dogs with nontraumatic hemoperitoneum secondary to splenic tumor rupture were included. A post hoc analysis was conducted on data from a nationwide prospective trial investigating novel treatments for canine hemangiosarcoma. The accuracy of preoperative staging was assessed by comparing ultrasonographic findings with intraoperative observations and histologic findings. On preoperative ultrasonography, there was a 20% incidence of liver lesions identified, with no association to liver lesions seen during operation. Notably, 22% of liver lesions observed during operation were missed on preoperative ultrasonography. The presence of liver lesions on preoperative ultrasonography was associated with a higher likelihood of a benign splenic tumor diagnosis. There was no association between the identification of liver lesions on preoperative ultrasonography and the presence of metastatic disease on liver biopsy, with a sensitivity and specificity of 19% and 82%, respectively. Additionally, ultrasound had low sensitivity in detecting intra-abdominal lesions beyond the liver and spleen, with 82% of these lesions missed preoperatively. This study challenges conventional perceptions around the approach to staging in dogs with hemoperitoneum. These findings advocate for a reevaluation of the staging approach, with more comprehensive modalities like whole-body CT or MRI potentially being more warranted.

Response to furmonertinib in a patient with non-small cell lung cancer harboring HER2 exon 21 insertion mutation: a case report

BackgroundThis is the first case report describing a patient with non-small cell lung cancer (NSCLC) harboring two rare human epidermal growth factor receptor 2 (HER2) exon 21 insertion mutations, who responded to furmonertinib treatment. Furmonertinib maybe one effective and economical treatment for NSCLC patients harboring HER2 mutations with minor side effects.Case descriptionWe present a case report of a 49-year-old female diagnosed with stage IV lung adenocarcinoma who complained of irritating dry cough symptoms followed by chest tightness. Firstly, we describe the patient’s treatment history, including failed third-line combination treatments of systemic chemotherapy with bevacizumab or carrelizumab or anlotinib, primary lung tumor recurrence, bilateral lung metastases progression, and new brain metastatic lesion detection. Next, we detail the patient’s fourth-line treatment with radiotherapy for brain metastases and two cycles of bevacizumab plus Abraxane and cisplatin, however, the disease progressed and relapsed. After that, comprehensive genomic profiling revealed two HER2 exon 21 insertion mutations. Subsequently, the patient received targeted therapy with furmonertinib and achieved 11 months of progression-free survival. The patient received pyrrotinib therapy for 2 months after disease progression, but the disease continued to progress. In October 2023, the patient received therapy with furmonertinib again, and a month later, the disease went into partial remission. However, the patient died due to hypoproteinemia combined with severe pneumonia in December 2023.ConclusionFurmonertinib may be effective for NSCLC patients with HER2 T8962A and L869R mutations and further studies are needed to confirm these results in prospective clinical trials.

CUTANEOUS SQUAMOUS CELL CARCINOMA AT NATIONAL HOSPITAL OF DERMATOLOGY AND VENEREOLOGY: A FOLLOW-UP RETROSPECTIVE STUDY

Objectives: This study assessed the postoperative follow-up attendance of patients with cutaneous squamous cell carcinoma (cSCC) who underwent management at the National Hospital of Dermatology and Venereology, following the protocol based on the American Academy of Dermatology (AAD) guidelines of care for the management of cutaneous squamous cell carcinoma in 2018 and the classification of low and high-risk cSCC according to the National Comprehensive Cancer Network (NCCN). Materials and Methods: A retrospective study involving 60 cSCC patients was conducted. The monitoring included recurrent cancerous lesions, new cancerous lesions (cSCC, BCC, melanoma, and other types), detection of metastatic lesions (lymph node and distant metastases), late complication monitoring (bad scarring), and mortality monitoring. Results: Depending on their stage and risk factors, cSCC patients underwent tumor removal by wide local excision (61.7%) or Mohs surgery (38.3%). Regional lymph node screening for metastasis included clinical examination, ultrasound, cytology, or sentinel lymph node biopsy (SLNB). Distant metastases in cSCC were infrequent, accounting for 1.7%, mainly presenting as lymph node metastases (6.7%). Patients were re-examined at least 5 years after treatment, revealing 4 of 56 patients with lymph node metastasis, 1 with bone metastasis, and 4 in the high-risk group who succumbed in the subsequent period. Conclusion: The management of cSCC, following the AAD guidelines and risk classification by NCCN, is effective, with treatment modifications as needed and strict monitoring being imperative. Received 19 June 2023Revised 18 September 2023Accepted 25 November 2023

Performance of [18F]FDG PET/CT versus FAPI PET/CT for lung cancer assessment: a systematic review and meta-analysis.

This article aims to compare the diagnostic performance of 18-fluorodeoxyglucose ([18F]FDG) PET/CT and fibroblast activating protein inhibitor (FAPI) PET/CT in the assessment of primary tumors, lymph nodes, and distant metastases in lung cancer patients. A systematic search was conducted on the Cochrane Library, Embase, and PubMed/MEDLINE databases from inception until November 1, 2022. Included studies assessed the use of FAPI PET/CT and [18F]FDG PET/CT in patients with lung cancer. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool was used to evaluate the risk of bias. A random variable model was used to analyze the diagnostic tests of the two imaging modalities. The sensitivity of FAPI PET/CT in detecting primary lung cancer lesions was 0.98 (95% CI: 0.88-1.00), while the sensitivity of [18F]FDG PET/CT was 0.99 (95% CI: 0.74-1.00). For the detection of metastatic lesions (lymph node metastases and distant metastases), FAPI PET/CT had a sensitivity of 0.99 (95% CI: 0.90-1.00), while the sensitivity of [18F]FDG PET/CT was 0.77 (95% CI: 0.66-0.85). However, the specificity of the two imaging modalities could not be assessed due to the lack of sufficient information on pertinent true negatives. In the diagnosis of metastatic lung cancer lesions, FAPI PET/CT demonstrated a higher sensitivity compared to [18F]FDG PET/CT. Therefore, FAPI PET/CT may be considered an alternative imaging modality for the assessment of primary lung cancer tumors, lymph node metastases, and distant metastases. FAPI may be an alternative to [18F]FDG in the assessment of primary lung cancer tumors, lymph node metastases, and distant metastases, which plays a very important role in treatment. • This article is to compare the performance of [18F]FDG PET/CT withFAPI PET/CT in the assessment of primary tumors, lymph nodes, and distant metastases in lung cancer. • However,FAPI PET/CT has a higher sensitivity for the diagnostic assessment of metastatic lung cancer lesions.

MP67-02 SALVAGE ROBOT-ASSISTED PSMA-RADIOGUIDED SURGERY IN RECURRENT PROSTATE CANCER USING A NOVEL DROP-IN GAMMA PROBE

You have accessJournal of UrologyCME1 Apr 2023MP67-02 SALVAGE ROBOT-ASSISTED PSMA-RADIOGUIDED SURGERY IN RECURRENT PROSTATE CANCER USING A NOVEL DROP-IN GAMMA PROBE Fabian Falkenbach, Sophie Knipper, Daniel Koehler, Fijs W.B. Van Leeuwen, Matthias N. Van Oosterom, Pim Van Leeuwen, Hilda De Barros, Henk Van Der Poel, Lars Budäus, Thomas Steuber, Markus Graefen, and Tobias Maurer Fabian FalkenbachFabian Falkenbach More articles by this author , Sophie KnipperSophie Knipper More articles by this author , Daniel KoehlerDaniel Koehler More articles by this author , Fijs W.B. Van LeeuwenFijs W.B. Van Leeuwen More articles by this author , Matthias N. Van OosteromMatthias N. Van Oosterom More articles by this author , Pim Van LeeuwenPim Van Leeuwen More articles by this author , Hilda De BarrosHilda De Barros More articles by this author , Henk Van Der PoelHenk Van Der Poel More articles by this author , Lars BudäusLars Budäus More articles by this author , Thomas SteuberThomas Steuber More articles by this author , Markus GraefenMarkus Graefen More articles by this author , and Tobias MaurerTobias Maurer More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Positron emission tomography / computed tomography (PET/CT) directed against the prostate-specific membrane antigen (PSMA) allows detection of even small and/or atypically localized metastatic prostate cancer (PCa) lesions at low PSA values. In a subset of patients with recurrent oligometastatic localized PCa PSMA-targeted radioguided surgery (PSMA-RGS) might be of value. Recently, a DROP-IN gamma-probe for intraoperative detection of metastatic lesions was introduced to facilitate a robot-assisted minimally invasive approach. Here, we report on our experience and the outcome of the first 16 patients treated with PSMA-RGS using the DROP-IN probe. METHODS: We assessed 16 patients treated with robot-assisted PSMA-RGS between 05/2021 and 03/2022. All patients presented with biochemical recurrence after radical prostatectomy (RP) and soft-tissue lesions on PSMA PET. Histological correlation, early PSA responses and Clavien-Dindo complications were evaluated. RESULTS: Median age was 64 years (IQR: 56-70.5 years). Prior to PSMA-RGS, overall median PSA was 0.55 ng/ml (IQR: 0.35-0.82 ng/ml). At robotic PSMA-RGS, intraoperative blood loss was estimated with 50 ml (IQR: 50-100 ml) and OR time was 158 minutes (IQR: 139-173 minutes). Metastatic soft-tissue lesions from PCa metastases could be removed in 15 (94%) patients. Postoperatively, overall median PSA was 0.18 ng/ml (IQR: 0.05-0.27 ng/ml). During the median follow-up of 4.2 months (IQR: 1.0-5.8 months), 4 patients experienced BCR and 1 patient received further therapy. One patient suffered from a Clavien-Dindo complication grade IIIb within three months from surgery (intraabdominal fluid collection necessitating drainage in general anesthesia). Limitations are the retrospective design and lack of a control group, as well as the small cohort. CONCLUSIONS: Robot-assisted PSMA-RGS using the novel DROP-IN gamma probe is a promising tool to enhance intraoperative detection of metastatic lesions in PCa during salvage surgery in a minimally invasive fashion. Further studies are needed to confirm our findings. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e943 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fabian Falkenbach More articles by this author Sophie Knipper More articles by this author Daniel Koehler More articles by this author Fijs W.B. Van Leeuwen More articles by this author Matthias N. Van Oosterom More articles by this author Pim Van Leeuwen More articles by this author Hilda De Barros More articles by this author Henk Van Der Poel More articles by this author Lars Budäus More articles by this author Thomas Steuber More articles by this author Markus Graefen More articles by this author Tobias Maurer More articles by this author Expand All Advertisement PDF downloadLoading ...

A prospective, multicenter head-to-head comparative study in patients with primary high-risk prostate cancer investigating the bone lesion detection of conventional imaging and 18F-PSMA-PET/CT.

Prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is an emerging staging tool for patients with primary high-risk prostate cancer (PCa). Patients with primary metastatic disease are staged using PSMA-PET/CT imaging, while previously published randomized clinical trials relied on conventional imaging (i.e., bone scintigraphy (BS) results. The aim of this study was to compare the ability of bone metastatic lesion detection and changes in staging for 18F-PSMA-PET/CT versus BS in high-risk PCa patients. 79 patients with high-risk PCa were prospectively staged using BS and subsequent 18F-PSMA-PET/CT before initial therapy. Patients who presented with a BS showing no metastases represented Group 1, and patients with a BS showing low-volume disease according to the CHAARTED criteria (<4 bone metastases, no metastases outside vertebral column or pelvis and no visceral metastases) represented Group 2. Metastatic risk group according to CHAARTED and treatment strategies based on both imaging modalities were assessed. A change of CHAARTED risk group was observed in 9/70 (12.8%) of patients in Group 1. In Group 2, a change of risk group was found in 66.7% of patients, due to either upstaging (4/9 patients (44.4%)) and downstaging (2/9 patients (22.2%)). Treatment changes due to use of a different imaging modality occurred in almost 20% of patients. In patients with negative for cancer results on BS, upstaging on 18F-PSMA-PET/CT occurred only infrequently. Moreover, 18F-PSMA-PET/CT resulted in both upstaging and downstaging in a substantial subset of patients with low-volume metastatic disease on BS. Treatment changes occurred in almost 20% of cases depending on imaging results.

Aberrant Cadherin11 expression predicts distant metastasis of gastric cancer.

The prognosis of gastric cancer (GC) is significantly affected by distant metastases and postoperative recurrences. Bone metastasis is one of the worst prognostic metastases in GC; however, its molecular mechanisms and predictive biomarkers remain elusive. In prostate and breast cancers, it has been reported that overexpression of Cadherin 11 (CDH11), a mesenchymal cell-cell contact factor, is known to be correlated with bone metastasis. Overexpression of CDH11 mRNA in bulk GC tissues has also been reported to be associated with a worse prognosis. However, a more precise evaluation of CDH11 expression in GC cells is necessary to establish a robust link between CDH11 and metastatic features of GC. We performed immunohistochemical analysis of CDH11 expression in 342 GC cases, of which specimens were obtained at the time of surgery, with a special focus on its aberrant membranous expression in GC cells. The correlations between aberrant CDH11 expression and distant metastases and the prognosis of GC cases were statistically investigated. Approximately half of the GC cases investigated showed aberrant expression of CDH11 in the GC cells of primary lesions. Aberrant CDH11 expression was statistically associated with bone metastasis of GCs. Moreover, metastases to the liver and distant lymph nodes were also statistically correlated with CDH11 expression. Aberrant CDH11 expression in GC cells in primary tumor lesions was shown to be a predictive biomarker of distant metastases in GC. GCs with CDH11 expression require preventive clinical attention for the detection of metastatic lesions.

Analysis of interreader agreement in structured reports of pelvic multiparametric magnetic resonance imaging using the METastasis Reporting and Data System for Prostate Cancer guidelines.

To evaluate interreader agreement on pelvic multiparametric magnetic resonance imaging (mpMRI) interpretation among radiologists using a structured reporting tool based on the METastasis Reporting and Data System for Prostate Cancer (MET-RADS-P) guidelines. A structured report for follow-up pelvic mpMRI for advanced prostate cancer (APC) patients was formulated based on MET-RADS-P guidelines. In total, 163 paired pelvic mpMRI examinations were performed from December 2017 to February 2021 on 105 patients with APC. These were retrospectively reviewed by two senior and two junior radiologists for metastatic lesion detection and were categorized by these readers using primary/secondary response assessment categories (RACs), with and without the structured report. Interreader agreement regarding metastasis detection and RAC scores was evaluated with Cohen's kappa and weighted Cohen's kappa statistics (K), respectively. The two senior radiologists showed higher agreement with the reference standard for metastasis detection using the structured report (S1: K = 0.83; S2: K = 0.73) compared with the conventional report (S1: K = 0.72; S2: K = 0.61). Junior radiologists showed similar results (J1: 0.66 vs. 0.59; J2: 0.65 vs. 0.57). The overall agreement between the two senior radiologists was excellent for the primary RAC pattern using the structured reports (K = 0.81) and was substantial for secondary RAC categorization (K = 0.75). The interreader agreement of the two junior radiologists was substantial for both primary and secondary RAC values (K = 0.76, 0.68). Good interreader agreement was found for the follow-up assessment of APC patients between radiologists, where the pelvic mpMRI was reported using MET-RADS-P guidelines. This improvement applied to both metastatic lesion detection and qualitative RAC assessment.

PS-R03-4: TRANSARTERIAL EMBOLIZATION, THORACIC SPINE DECOMPRESSION AND FUSION OF METASTATIC PHEOCHROMOCYTOMA: A CASE REPORT

Surveillance of metastatic lesions and biochemical control of catecholamines in patients with malignant pheochromocytoma remain a fundamental problem to be solved. Here we present a 60-year-old male who visited a local clinic because of headache, sweating, malaise, and loss of body weight. Hypertension, orthostatic hypotension, along with remarkable increase in serum and urine noradrenaline, and urine metanephrine and vanillylmandelic acid were noted, and pheochromocytoma was suspected accordingly. Magnetic resonance imaging failed to reveal adrenal gland or sympathetic plexuses, yet it uncovered metastatic lesions in the liver and spine. Functional imaging study using 131I-Metaiodobenzylguanidine (MIBG) scan detected notable uptake in the spinal lesion, albeit not in the hepatic lesion. On the other hand, positron emission tomography with fluorodeoxyglucose (FDG-PET) disclosed FDG uptake both in the hepatic and spinal masses. Biopsy of the hepatic tumors revealed chromogranin A-positive clusters of cells, a finding consistent with metastatic pheochromocytoma. Transarterial embolization (TAE) of the metastatic tumors in the liver was performed for the purpose of tumor mass reduction. Additionally, TAE followed by resection of the spinal lesion was conducted. Pathological examination of the spinal tumor also showed chromogranin A-positive cells, leading to diagnosis of malignant pheochromocytoma. Crucially, TAE of the liver and spinal tumors resulted in dramatic reduction of catecholamine production, likely constituting an effective therapeutic strategy against metastatic pheochromocytoma (Homma, et al. Hypertens Res 2006). Afterwards, the patient became unable to walk because of weakness in the left leg at the age of 64. It seemed attributed to spinal cord compression from the tumor at the level of thoracic vertebrae 7. The patient underwent posterior decompression and fusion, and his muscle strength of the left leg was recovered. At the age of 65, the patient developed paralytic ileus following a surgery against metastatic tumors in the skull. In this case report, we discuss early detection of metastatic lesions and biochemical control of catecholamines in patients with malignant pheochromocytoma.

Imaging techniques for ocular neoplasia

Background: Novel ocular imaging modalities have greatly impacted the diagnosis and management of different types of ocular neoplasia. In this narrative review, we summarize the practical features of popular and novel imaging modalities for ocular tumors.&#x0D; Methods: Four databases, including PubMed/MEDLINE, Web of Science, Scopus, and Google Scholar, were searched from January 1, 2000 to August 31, 2022. Articles reporting different imaging modalities for diagnosing or monitoring treatment responses of ocular tumors were extracted using various combinations of the following keywords: ocular neoplasia, positron emission tomography or PET, single-photon emission computed tomography or SPECT, optical coherence tomography or OCT, OCT angiography or OCTA, computed tomography or CT, ultrasonography or US, ultrasound biomicroscopy or UBM, and magnetic resonance imaging or MRI.&#x0D; Results: Various ocular imaging modalities had different accuracies as adjunctive tools for detecting or managing ocular tumors. Anterior ultra-high-resolution optical coherence tomography (OCT) could be used to evaluate images with &lt; 5-µm resolution. OCT angiography provided deeper insight into retinal vascular changes associated with the malignant transformation of choroidal melanoma. OCT in children altered the diagnosis of suspicious retinoblastoma in 3% of the cases and treatment plan in 11% of the cases. While positron-emission tomography (PET)/computed tomography (CT) allowed the detection of metastatic lesions of choroidal melanoma by full-body scanning, single-photon emission CT was more sensitive compared to PET in detecting choroidal melanoma. Ultrasound biomicroscopy, with an accuracy exceeding 92.5%, could detect retinal calcification in lesions measuring 2–3 mm. Magnetic resonance imaging (MRI) had better contrast compared to ultrasound biomicroscopy and higher sensitivity compared to CT in detecting post-laminar optic nerve invasion. However, MRI had a lower spatial resolution compared to OCT. Further development of imaging modalities and their application in drug development would improve the treatment of ocular tumors.&#x0D; Conclusions: Although diagnosing ocular tumors depend on clinical characteristics, innovations in ocular imaging have enabled early diagnosis and timely, appropriate management of ocular neoplasia, which are conducive to favorable visual outcomes and increased life expectancy. Further systematic reviews and meta-analyses of primary studies focusing on a specific imaging modality in ocular neoplasia could precisely determine the diagnostic accuracy of each imaging modality to better guide eye practitioners with efficient diagnostic or therapeutic approaches for these sight- or life-threatening entities. Imaging modalities may play a major role in drug development in the future.

Management of Patients with Recurrent and Metachronous Oligometastatic Prostate Cancer in the Era of PSMA PET.

Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) scans have higher sensitivity and specificity for detecting lymph nodes or metastatic disease relative to conventional imaging in prostate cancer staging. Since its FDA approval and incorporation into treatment guidelines, the use of PSMA PET has increased in patients undergoing initial staging, those with recurrence after initial definitive treatment, and patients with metastatic disease. Although the early detection of metastatic lesions is changing disease management, it is unclear whether this impact on management translates into clinical benefit. This review will summarize evidence pertaining to the change in patient management due to PSMA PET use and will discuss the implications of PSMA PET on treatment decisions in prostate cancer, particularly in the settings of biochemical recurrence and metachronous oligometastatic disease.

The role of 18F-FDG PET/CT in patients with synchronous multiple primary malignant neoplasms occurring at the same time.

Synchronous multiple primary malignant neoplasms occurring at the same time (SMPMNS) are not currently uncommon in clinical oncological practice; however, the diagnostic performance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for SMPMNS needs further elucidation. This study aimed to evaluate the application of 18F-FDG PET/CT in patients with SMPMNS. The clinical and imaging data of 37 patients with SMPMNS who had undergone 18F-FDG PET/CT from October 2010 to December 2020 were retrospectively analyzed. The kappa consistency test was applied to evaluate the consistency of the diagnostic performance between PET/CT and conventional imaging (CI). The sensitivity, specificity, and accuracy of PET/CT and CI in the detection of metastatic lesions were compared. This retrospective diagnostic study included 74 lesions identified in 37 patients with SMPMNS, with 94.6% of patients having double primary tumors. Of the incidences of SMPMNS, 18.9% occurred in the same organ system, with respiratory tumors being the most common type of neoplasm (43.2%) and the lung being the most common primary site (40.5%). The overall survival of SMPMNS patients without metastases was longer than that of those with metastases (χ 2=12.627, p=0.000). The maximum standardized uptake value (SUVmax), the SUVmax ratio (larger SUVmax/smaller SUVmax), and the difference index of SUVmax (DISUVmax) [(larger SUVmax-smaller SUVmax)/larger SUVmax] of the primary lesions ranged from 0.9 to 41.7 (average=12.3±7.9), from 0.3 to 26.7 (average=4.4±6.9), and from 0.0% to 96.3% (average=50.3%±29.3%), respectively. With regard to diagnostic accuracy, PET/CT and CI showed poor consistency (κ=0.096, p=0.173). For the diagnosis of primary lesions (diagnosed and misdiagnosed), PET/CT and CI also showed poor consistency (κ=0.277, p=0.000), but the diagnostic performance of PET/CT was better than that of CI. In the diagnosis of metastases, the patient-based sensitivity, specificity, and accuracy of PET/CT were 100.0%, 81.8%, and 89.2%, respectively, while those of CI were 73.3%, 100.0%, 89.2%, respectively. The sensitivity and specificity values were significantly different, with PET/CT having higher sensitivity (p=0.02) and CI showing higher specificity (p=0.02). 18F-FDG PET/CT improves the diagnostic performance for SMPMNS and is a good imaging modality for patients with SMPMNS.

Circulation Time-Optimized Albumin Nanoplatform for Quantitative Visualization of Lung Metastasis via Targeting of Macrophages.

The development of molecular imaging probes to identify key cellular changes within lung metastases may lead to noninvasive detection of metastatic lesions in the lung. In this study, we constructed a macrophage-targeted clickable albumin nanoplatform (CAN) decorated with mannose as the targeting ligand using a click reaction to maintain the intrinsic properties of albumin in vivo. We also modified the number of mannose molecules on the CAN and found that mannosylated serum albumin (MSA) harboring six molecules of mannose displayed favorable pharmacokinetics that allowed high-contrast imaging of the lung, rendering it suitable for in vivo visualization of lung metastases. Due to the optimized control of functionalization and surface modification, MSA enhanced blood circulation time and active/passive targeting abilities and was specifically incorporated by mannose receptor (CD206)-expressing macrophages in the metastatic lung. Moreover, extensive in vivo imaging studies using single-photon emission computed tomography (SPECT)/CT and positron emission tomography (PET) revealed that blood circulation of time-optimized MSA can be used to discern metastatic lesions, with a strong correlation between its signal and metastatic burden in the lung.

Special issue "The advance of solid tumor research in China": 68Ga-PSMA-11 PET/CT for evaluating primary and metastatic lesions in different histological subtypes of renal cell carcinoma.

Conventional imaging examinations are not sensitive enough for the early detection of recurrent or metastatic lesions in renal cell carcinoma (RCC) patients. We aimed to explore the role of 68 Ga-prostate specific membrane antigen (PSMA)-11 positron emission tomography (PET)/computed tomography (CT) in the detection of primary and metastatic lesions in such patients. We retrospectively analyzed 50 RCC patients who underwent 68 Ga-PSMA-11 PET/CT from November 2017 to December 2020. We observed a higher median accuracy and tumor-to-background maximum standard uptake value (SUVmax ) ratio (TBR) of 68 Ga-PSMA-11 PET/CT in clear cell RCC (ccRCC; 96.57% and 6.00, respectively) than in non-clear cell RCC (ncRCC; 82.05% and 2.99, respectively). The accuracies in detecting lesions in the renal region, bone, lymph nodes and lungs in ccRCC were 100.00%, 95.00%, 98.08% and 75.00%, respectively, and those in the renal region, bone and lymph nodes in ncRCC were 100.00%, 86.67% and 36.36%, respectively. The median TBRs of the lesions from the above locations were 0.38, 10.96, 6.69 and 13.71, respectively, in ccRCC and 0.13, 4.02 and 0.73, respectively, in ncRCC. The PSMA score evaluated with immunohistochemistry was correlated with the SUVmax (P=.046) in RCC. Higher PSMA scores were observed in ccRCC than in ncRCC (P=.031). 68 Ga-PSMA-11 PET/CT resulted in changes in clinical management in 12.9% (4/31) of cases because of the discovery of new metastases not detected with conventional imaging. These results indicate that 68 Ga-PSMA-11 PET/CT is a promising method for the detection of metastatic lesions in ccRCC, especially for those in the bone and lymph nodes.

PET/CT with &lt;sup&gt;18&lt;/sup&gt;F-FDG and &lt;sup&gt;18&lt;/sup&gt;F-Choline in the Detection of Metastases of Hepatocellular Carcinoma. Clinical Case

Purpose: Analysis of a clinical case of detection of metastatic lesions of the mediastinal subcarinal lymph node in a patient with hepatocellular liver cancer using positron emission tomography combined with computed tomography (PET/CT).Material and methods: A patient with moderately differentiated hepatocellular liver cancer after surgical treatment and targeted therapy revealed a biochemical relapse. Complex examination (computed tomography, magnetic resonance imaging) revealed no pathological changes. PET/CT revealed pathological accumulation of 18F-choline in the subcarinal lymph node. After performing transbronchial lymph node biopsy and histological examination metastatic lesion was confirmed.Conclusion: Whole body PET/CT scan revealed rare metastases of hepatocellular cancer in biochemical recurrence — in the mediastinal subcarinal lymph node, in the absence of other manifestations of the disease. Whole body PET/CT is the method of choice for suspected extrahepatic localization of hepatocellular carcinoma progression.

Metastasis of pulmonary adenocarcinoma to the oral cavity: A case report and literatures review of the last 30 years

AbstractBackgroundMetastases of pulmonary adenocarcinomas (pADCs) into the oral cavity are rare and sometimes misdiagnosed because of clinical findings that are similar to benign or inflammatory lesions.Case presentationA 79‐year‐old man had a soft elastic mass in the oral cavity. Cytological and histological examinations revealed a metastasis of a pADC that was vimentin‐positive.ConclusionOral cytology may be valuable for the detection of metastatic lesions in the oral cavity. Palliative surgery for maintaining the oral function may be beneficial to improve quality of life, and it did not affect survival time in Kaplan–Meier analysis from the literature review.

Comparison of [68Ga]Ga-FAPI-04 and [18F]-FDG for the detection of primary and metastatic lesions in patients with gastric cancer: a bicentric retrospective study.

The low sensitivity of [18F]-fluorodeoxyglucose ([18F]-FDG) for the diagnosis of gastric cancer limits its application. In this study, we aimed to investigate the potential advantage of [68Ga]Ga-FAPI-04 over [18F]-FDG in the evaluation of gastric cancer. This was a bicentric retrospective analysis of a prospective parent study (clinical trial: HS-KY-2020-826 (Huashan Hospital) and DF-2020-102 (Shanghai East Hospital)). Thirty-eight patients with gastric cancer (31 with adenocarcinoma and 7 with signet ring cell carcinoma) were included in this study. All of the participants underwent [68Ga]Ga-FAPI-04 and [18F]-FDG imaging by positron emission tomography (PET)/computed tomography (CT) or PET/magnetic resonance (MR). The scans were interpreted by two experienced nuclear medicine physicians, and the maximum standardized uptake value (SUVmax) was calculated. Histopathological findings obtained from biopsy or resected surgical specimens were used as a reference for the final diagnosis. For the detection of primary gastric cancer, the sensitivities of [68Ga]Ga-FAPI-04 PET and [18F]-FDG PET were 100% (38/38) and 82% (31/38), respectively (P = 0.016). Four cases of adenocarcinoma and three cases of signet ring cell carcinoma were missed by [18F]-FDG PET. The mean SUVmax of [68Ga]Ga-FAPI-04 in tumours greater than 4cm (11.0 ± 4.5) was higher than that in tumours less than 4cm (4.5 ± 3.2) (P = 0.0015). The mean SUVmax of [68Ga]Ga-FAPI-04 was higher in T2-4 tumours (9.7 ± 4.4) than in T1 tumours (3.1 ± 1.5) (P = 0.0002). For the detection of metastatic lesions, the sensitivities of [68Ga]Ga-FAPI-04 PET and [18F]-FDG PET in 10 patients with regional lymph node metastasis and distant metastasis were 6/10 and 5/10, respectively. In this selected cohort, [68Ga]Ga-FAPI-04 PET had a superior detection rate than [18F]-FDG PET for primary gastric cancer. [68Ga]Ga-FAPI-04 PET could provide better performance with regard to gastric cancer diagnosis and staging. Prospective clinical trials are warranted.

Abstract P3-01-07: Early detection of metastatic breast cancer through gene expression and cell heterogeneity at an engineered metastatic niche

Abstract Background: Current technology limits the detection of metastatic lesions until the patient becomes symptomatic or radiological evidence is identified, and thus invasive cancer cells are not detectable prior to their colonization in distant organs. We have developed a biomaterial implant that serves as a synthetic metastatic niche that recruits tumor cells prior to their accumulation in the lung, a natural metastatic niche. We aimed to dissect the heterogeneity of stromal and immune cells at the synthetic and lung metastatic niches over time, thereby identifying changes in cell populations, phenotypes, and gene expression that could be used for the molecular staging of metastatic disease. Methods: Porous polycaprolactone scaffolds (5 mm diameter x 2 mm height) were implanted subcutaneously into Balb/c mice two weeks before triple negative murine breast cancer cells (4T1) were inoculated into the mammary fat pad. We tracked disease progression in the lung from a pre-metastatic niche (7 days post-inoculation) to micrometastases (14 days) to overt metastatic disease (21 days). Ten genes were selected from the TaqManTM Open Array Mouse Inflammation Panel to develop a PCR-based signature and single value decomposition (SVD) score in the scaffold that successfully delineated metastatic staging. Furthermore, the scaffold and lung were analyzed through single cell RNA-sequencing (Drop-seq) to identify heterogeneity and contributions of each cell type. Results: Ten genes were identified from Open Array of the scaffolds that directly correlated to disease stage in the lungs – S100a8, S100a9, Pglyrp1, Ltf, Camp, Ela2, and Chi3l3 increased with metastatic progression, while Bmp15, Ccl22 and Ccr7 decreased. SVD was applied to establish a single score from the scaffold that could be used for accurate molecular staging. Scaffolds were scored on a scale from 0 to 1, where a value of 0.2 – 0.3 generally correlated to pre-metastatic disease, 0.4 - 0.8 indicated micrometastases and 0.8 – 1.0 demarked metastasis. This model successfully predicted disease stage with an area under the curve of 0.878. When the scaffold-derived gene signature was applied to the lung metastases (21 days), the output was comparable to the scaffold, further demonstrating the physiological relevance of the implants. Single cell analysis indicated that the genes in the signature were primarily expressed by macrophages and neutrophils. After 7 days, 22% of macrophages and 83% of neutrophils were classified as tumor associated cells in the scaffold. In contrast, only 16% of macrophages and 44% of neutrophils in the lung were tumor associated at this time point. These findings support the hypothesis that the scaffolds could be used as early surrogates for the pre-metastatic niche, becoming responsive prior to their biological metastatic counterpart. Moreover, this finding was demonstrated through changes in T cell phenotype, specifically loss of cytotoxic Cd8+ T cells. After 7 days, Cd8+ T cells in the scaffolds decreased by 35%. Whereas Cd8+ T cells in the lungs decreased by 35% after 14 days. Conclusions: A biomaterial scaffold was employed as a synthetic niche that recruits metastatic tumor cells. These scaffolds established a molecular signature of metastatic breast cancer using a 10-gene panel. Additionally, single cell analysis identified the cell types that induce this signature and the disease-associated changes that occur in the scaffold earlier than the lung. In summary, we have shown the potential of a biomaterial scaffold to act as a surrogate metastatic niche that can be used to delineate disease progression and understand the role of specific cell types in the formation of this niche. Mechanistic investigation into the synthetic niche may identify novel therapeutic targets that could be activated to inhibit the advent of metastasis. Citation Format: Sophia M Orbach, Robert S Oakes, Michael D Brooks, Grace G Bushnell, Pridvi Kandagatla, Max S Wicha, Jacqueline S Jeruss, Lonnie D Shea. Early detection of metastatic breast cancer through gene expression and cell heterogeneity at an engineered metastatic niche [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-01-07.

Deep-UV excitation fluorescence microscopy for detection of lymph node metastasis using deep neural network

Deep-UV (DUV) excitation fluorescence microscopy has potential to provide rapid diagnosis with simple technique comparing to conventional histopathology based on hematoxylin and eosin (H&E) staining. We established a fluorescent staining protocol for DUV excitation fluorescence imaging that has enabled clear discrimination of nucleoplasm, nucleolus, and cytoplasm. Fluorescence images of metastasis-positive/-negative lymph nodes of gastric cancer patients were used for patch-based training with a deep neural network (DNN) based on Inception-v3 architecture. The performance on small patches of the fluorescence images was comparable with that of H&E images. Gradient-weighted class activation mapping analysis revealed the areas where the trained model identified metastatic lesions in the images containing cancer cells. We extended the method to large-size image analysis enabling accurate detection of metastatic lesions. We discuss usefulness of DUV excitation fluorescence imaging with the aid of DNN analysis, which is promising for assisting pathologists in assessment of lymph node metastasis.

Response assessment using 68 Gallium (68Ga) Prostate-Specific Membrane Antigen (PSMA) Positron Emission Tomography - Computed Tomography (PT/CT) inpatients with oligometastatic prostate cancer undergoing Stereotactic Body Radiotherapy (SBRT)

SBRT delivers ablative radiation doses to smaller volumes than classical radiotherapy potentially risking higher intraosseous out of field recurrences. PSMA PET/CT has high sensitivity for the detection of metastatic lesions in recurrent prostate cancer. We utilized PSMA PET/CT imaging to study metabolic response and local control of bone metastasis treated with SBRT in oligo-metastatic prostate cancer patients. We identified patients who had oligo-recurrent prostate cancer detected by PSMA PET/CT scan with a PSMA RADS 3B to 5, were treated with SBRT and had follow-up post-treatment PSMA PET/CT scans in an IRB approved database. Patients underwent CT simulation with a vacuum immobilization cradle. PSMA PET was fused onto the planning CT and GTV was delineated according to PSMA uptake and blastic/lytic findings. The CTV for vertebra was according to International Spinal Radiosurgery Consortium. In other bones, CTV was a 2 cm expansion of the GTV in the adjacent bone without additional margins for PTV. All SBRT patients were treated with 3-5 fractions to a total dose 27- 40 Gy. Clinical follow-up was every 6 months. PSMA PET/CT scans were reviewed by a nuclear medicine and radiology consultant. Twelve patients with 15 bone metastases located in the spine, pelvis and rib were treated. The median follow-up was 26.5m. Median interval to post treatment PT/CT was 17 months (3–39). Eight patients received Androgen Deprivation Therapy. Median pre -treatment PSA was 10 ng/ml (0.56–44) and post treatment PSA nadir was 0.7 ng/ml (0.01-4.3) (p=0.02) with a median time to nadir of 7 months (2-12).Complete PSMA response was observed in 14 of 15 (93%) lesions, with reduction in the median SUV pre RT from 5.7 to 1.1 (p <0.0003). One lesion had partial response with residual PSMA avidity which increased over time, thus in-field control was 93%. No patient developed out of field intraosseous metastasis thus local control of treated bone was 93 %. 5/12 patients remained free of metastasis at 2 years. 5/12 developed oligo-metastasis in un-treated bones and 2 patients developed widespread metastasis. No adverse skeletal events were recorded. SBRT to oligo metastatic prostate cancer bone lesions, planned using PSMA PET/CT with adequate margins is associated with excellent osseous control. Longer follow-up is required to determine if SBRT provides greater clinical benefit than standard fractionation for oligometastatic prostate cancer patients.Abstract 3323; Table 1Variablen (%)Median Age73.1 (52-86)12 (100)Gleason score6 (1)1(8)3+4=7 (2)3(25)4+3=7 (3)3(25)8 (4)1(8)9 (5)3(25)10 (5)1(8)Primary treatmentSurgery4 (33)Radiation1 (8)Radiation + ADT6 (50)Brachytherapy1 (8)Location:Spine9 (60)Pelvis5 (33)Ribs1 (7)Median PSA ng/mlPre-treatment10.5 (0.6-45)Post-treatment0.7 (0.01-4.3)Median SUVPre-treatment5,7 (2,1-13)Post-treatment1.1 (0,2-3,1)Androgen Deprivation TherapyYes8 (67)No4 (33)Total Dose (No. of fractions)30 (3)9 (60)27 (3)4 (26)36 (6)1 (7)40 (5)1 (7) Open table in a new tab