High Standardized Uptake Value Research Articles

P1.08-019 Risk Factors and Survival of Occult N2 Lymph Node Metastasis in NSCLC Patients with Clinical N0-1 Diagnosed by Preoperative PET-CT

Accurate staging of NSCLC for N2 lymph node metastasis is crucial for prognosis and optimal therapy. Suggestion of occult mediastinal lymph node metastasis could help physicians for decision making of staging and management. This study was aimed to know risk factors and survival for occult N2 lymph node metastasis in NSCLC patients with clinical N0 and N1 diagnosed by preoperative PET-CT. This study was evaluated NSCLC patients with clinical N0-1 who underwent R0 lung resection with complete lymphadenectomy. Clinicopathological factors such as tumor size, tumor location, tumor laterality, histology, and FDG uptake were analyzed to delineate risk factors. Overall survival was analyzed. Between November 2005 and December 2014, the incidence of N2 lymph node metastasis was 13.3% (22 patients of 166). The risk factors for pN2 were central located tumor (p<0.001), larger tumor size on CT (p=0.038), and high SUV on PET (p=0.001). Patients having risk factor of central tumor had shorter survival, significantly (p<0.001). The central located tumor, larger tumor size on CT, and high SUV of primary tumor were predictable factors for N2 lymph node metastasis in clinical N0-1 NSCLC. Therefore, these factors may help determined whether to enforce cN0-1 patients to do mediastinal staging selectively.

P1.03-031 Gynecological Malignancies and Imaging Patterns. An Interesting Case Report and Literature Surveillance

Gynecologic malignancies are a heterogeneous group of common neoplasms in women. Thoracic abnormal findings exhibit various imaging patterns and are usually associated with locally invasive primary neoplasms with intra-abdominal spread. It is not rare, thoracic involvement occurring years post first diagnosis or as an isolated finding in patients without evidence of intra-abdominal neoplastic involvement. Thoracic metastases from gynecologic carcinomas typically manifest as pulmonary nodules and lymphadenopathy. Ovarian cancer often presents small pleural effusions and subtle pleural nodules whereas metastatic lung lesions, lymph nodes, and pleura are thought to present calcification or mimicking granulomatous disease. Metastases from fallopian tube carcinomas have imaging features identical to ovarian cancers. Most cervical cancers are of squamous histology, and while solid pulmonary metastases are more common, the cavitary metastatic lesions occur more often. Metastatic choriocarcinoma to lung characteristically exhibits solid pulmonary nodules. There are also reported pulmonary metastases from gynecologic malignancies with characteristic features such as cavitation (as awaited in squamous cell cervical cancer) and the “halo” sign (in hemorrhagic metastatic choriocarcinoma lesions) at computed tomography. We report a case with a mass in left paratracheal area invading the lung hinting primary lung cancer. The female patient, 36 years old with previous medical history of resected cervical cancer, underwent endoscopy with aim to have transbronchial aspiration but unfortunately the samples taken were consistent of inflammation infiltration. Thus she underwent thoracotomy due to high SUV (12) uptake points at PET CT with intention to exclude lung cancer. She had the mass removed with all the surrounding lung parenchyma but unfortunately the final histologic report documented metastatic infiltration from cervical cancer in competence with her previous medical history 6 years ago (Ib stage with radiotherapy only treated in adjuvant basis). She recovered well and was initiated chemotherapy for the gynecological malignancy stated She is now 2 years later alive, with no residual disease The basic is that malignancies are always suspected to be primary originated but the medical previous history should not be ignored, even the imaging tests tend to resemble to other entities. Therefore, radiologists should consider the presence of locoregional disease in combination with elevated tumor marker levels when interpreting imaging studies and all previous medical history of the patient’s malignancy to exclude metastatic disease.

P1.03-003 The Warburg Effect: Persistence of Stem Cell Metabolism in Lung Cancer as Failure of Differentiation

Two recent observations are relevant to explaining Warburg's observation the cancers constitutively utilize glycolysis in the presence of oxygen sufficient for oxidative phosphorylation. First, the metabolism of stem cells has been shown to be constitutive (‘aerobic’) glycolysis, with differentiation involving a transition to oxidative phosphorylation. Second, the degree of glucose uptake by a cancer has been associated with histologic differentiation. We hypothesized that the high levels of glucose uptake observed in poorly differentiated lung cancers may reflect persistence in cancers of the glycolytic metabolism of stem cells that fail to fully differentiate. Tumor glucose uptake was measured by FDG-PET in 859 patients with histologically diverse cancers including NSCLC. We used normal mixture modeling to explore SUV distributions and tested for association between glucose uptake and histological differentiation, risk of lymph node metastasis, and survival. Using microarray data, we performed pathway and transcription factor analyses to compare tumors with high/low glucose uptake. Well-differentiated NSCLC had low FDG uptake, and moderately/poorly differentiated tumors higher uptake. The distribution of FDG-PET uptake was modal with a low peak at SUV 2-4 and a high peak at SUV 8-11. The cancers in the two peaks were clinically distinct in terms of the risk of nodal metastases and of death. Carbohydrate metabolism-related and pentose/nucleotide synthesis-related genes were elevated in the high SUV clusters, Krebs cycle/glutamine metabolism-related genes were elevated in the low SUV mode samples. Expression of Myc target genes was associated with SUV mode, but Nanog, Sox2, Oct4 and PRC2 where not. The biological basis for the Warburg effect is persistence of stem cell metabolism in lung cancers as a failure to transition from glycolysis-utilizing undifferentiated cells to oxidative phosphorylation-utilizing differentiated cells. Lung cancers cluster along the differentiation pathway into two groups. Our results have implications for determining prognosis, cancer screening and surveillance after resection.

Macrovascular invasion is not an absolute contraindication for living donor liver transplantation.

The indication of liver transplantation (LT) for the treatment of advanced hepatocellular carcinoma (HCC) is expanding. However, portal vein tumor thrombus (PVTT) has been still accepted as an absolute contraindication. We experienced an unexpectedly good prognosis in selected patients. Therefore, we tried to identify the prognostic factors after LT for HCC with major PVTT. Among 282 patients who underwent living donor liver transplantation (LDLT) for HCC from January 2009 to December 2013, 11 (3.9%) patients with major PVTT that was preoperatively diagnosed were investigated. The 1-, 3-, and 5-year recurrence-free survival rates were 63.6%, 45.5%, and 45.5%, respectively, and all recurrent cases showed intrahepatic and extrahepatic recurrence. The 1-, 3-, and 5-year overall survival rates were 72.7%, 63.6%, and 63.6%, respectively, and 2 patients with delayed recurrence survived approximately 5 years after LT. Main portal vein (PV) invasion (P < 0.01), high alpha-fetoprotein × protein induced by vitamin K absence/antagonist-II (AP) score (≥20,000; P < 0.01), high standardized uptake value (SUV) ratio (tumor/background liver) in positron emission tomography (≥2.1; P < 0.01), and a large original tumor (≥7 cm; P = 0.03) were significant risk factors for recurrence. In conclusion, if the PVTT has not expanded to the main PV and the AP score is not high, we can consider LDLT as a curative treatment option. Liver Transplantation 23:19-27 2017 AASLD.

Risk stratification for locally advanced hepatocellular carcinoma using pretreatment alpha-foetoprotein and 18 F-fluoro-2-deoxyglucose positron emission tomography.

We investigated the significance of 18 F-fluoro-2-deoxyglucose positron emission tomography (18 F-FDG PET) parameters and alpha-foetoprotein (AFP) levels in patients with locally advanced hepatocellular carcinoma (LA-HCC). We retrospectively analysed data of 228 patients with LA-HCC who underwent pretreatment 18 F-FDG PET between January 2003 and December 2013. All patients were treated using liver-directed therapy involving radiotherapy. The maximum standardized uptake values (SUVs) and tumour-to-extratumoural liver SUV ratios were calculated, and pretreatment AFP values were obtained. Patients were divided into high and low maximum SUV (SUVmax) groups according to a SUV cut-off of 4.825 determined via receiver-operating characteristic analysis. High AFP level (>550ng/mL) and high SUVmax were significant predictors of overall and progression-free survival. Better treatment responses and longer median progression-free and overall survival were observed in the low SUVmax group, compared to the high SUVmax group. Similar results were obtained for SUV ratio-based (cut-off value: 2.355) and AFP-based analyses (cut-off value: 550ng/mL). Three risk groups were identified using the double biomarkers of SUVmax and AFP value as strong prognosticators predictive of survival outcomes. This risk stratification was identified as a prognosticator of survival outcomes, even after subgroup analyses. Furthermore, in high risk group, significantly high extrahepatic failure was shown while in low risk group, significantly low intrahepatic failure. Clinical significance of double biomarkers, SUV and AFP, could be translated into risk stratification for LA-HCC. It could be a valuable tool for survival outcome prediction.

Body Mass Index with Tumor 18F-FDG Uptake Improves Risk Stratification in Patients with Breast Cancer.

PurposeTo investigate the combined prognostic impact of body mass index (BMI) and tumor standardized uptake value (SUV) measured on pretreatment 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in patients with breast cancer.MethodsWe evaluated a cohort of 332 patients with newly diagnosed breast cancer (stage I-III) who underwent pretreatment FDG PET/CT followed by curative resection. Patients were categorized as overweight (BMI ≥ 23 kg/m2) or normal weight (BMI < 23 kg/m2). Primary tumor maximum SUV was measured by FDG PET/CT. Associations between BMI and tumor SUV with disease recurrence were assessed using Cox regression models.ResultsMedian follow-up was 39 months. There were 76 recurrences and 15 cancer-related deaths. Multivariable Cox regression analysis demonstrated that high tumor SUV (hazard ratio [HR] = 1.75; 95% CI, 1.02–3.02; P = 0.044) and overweight (HR = 1.84; 95% CI, 1.17–2.89; P = 0.008) were independent poor prognostic factors. Positive hormone receptor status was an independent predictor of favorable outcome (HR = 0.42; 95% CI, 0.26–0.68; P < 0.001). Overweight patients with high tumor SUV had a two-fold risk of recurrence compared to patients with normal weight or low tumor SUV after adjusting for clinical stage and tumor subtype (HR = 2.06; 95% CI, 1.30–3.27; P = 0.002).ConclusionsIn patients with breast cancer, higher tumor SUV was associated with a more adverse outcome particularly in overweight women. BMI status combined with tumor SUV data allows better risk-stratification of breast cancer, independent of clinical stage and tumor subtype.

Metabolomics of Breast Cancer Using High-Resolution Magic Angle Spinning Magnetic Resonance Spectroscopy: Correlations with 18F-FDG Positron Emission Tomography-Computed Tomography, Dynamic Contrast-Enhanced and Diffusion-Weighted Imaging MRI.

PurposeOur goal in this study was to find correlations between breast cancer metabolites and conventional quantitative imaging parameters using high-resolution magic angle spinning (HR-MAS) magnetic resonance spectroscopy (MRS) and to find breast cancer subgroups that show high correlations between metabolites and imaging parameters.Materials and methodsBetween August 2010 and December 2013, we included 53 female patients (mean age 49.6 years; age range 32–75 years) with a total of 53 breast lesions assessed by the Breast Imaging Reporting and Data System. They were enrolled under the following criteria: breast lesions larger than 1 cm in diameter which 1) were suspicious for malignancy on mammography or ultrasound (US), 2) were pathologically confirmed to be breast cancer with US-guided core-needle biopsy (CNB) 3) underwent 3 Tesla MRI with dynamic contrast-enhanced (DCE) and diffusion-weighted imaging (DWI) and positron emission tomography-computed tomography (PET-CT), and 4) had an attainable immunohistochemistry profile from CNB. We acquired spectral data by HR-MAS MRS with CNB specimens and expressed the data as relative metabolite concentrations. We compared the metabolites with the signal enhancement ratio (SER), maximum standardized FDG uptake value (SUV max), apparent diffusion coefficient (ADC), and histopathologic prognostic factors for correlation. We calculated Spearman correlations and performed a partial least squares-discriminant analysis (PLS-DA) to further classify patient groups into subgroups to find correlation differences between HR-MAS spectroscopic values and conventional imaging parameters.ResultsIn a multivariate analysis, the PLS-DA models built with HR-MAS MRS metabolic profiles showed visible discrimination between high and low SER, SUV, and ADC. In luminal subtype breast cancer, compared to all cases, high SER, ADV, and SUV were more closely clustered by visual assessment. Multiple metabolites were correlated with SER and SUV in all cases. Multiple metabolites showed correlations with SER and SUV in the ER positive, HER2 negative, and Ki-67 negative groups.ConclusionHigh levels of PC, choline, and glycine acquired from HR-MAS MRS using CNB specimens were noted in the high SER group via DCE MRI and the high SUV group via PET-CT, with significant correlations between choline and SER and between PC and SUV. Further studies should investigate whether HR-MAS MRS using CNB specimens can provide similar or more prognostic information than conventional quantitative imaging parameters.

Follicular dendritic cell tumour/sarcoma: a commonly misdiagnosed tumour in the thorax

Follicular dendritic cell sarcoma is a rare tumour reported to occur occasionally in association with the hyaline-vascular type of Castleman's disease (HVCD). Most cases arise in lymph nodes, although extranodal presentation is described. Clinical, radiological and histological characteristics, including diagnosis on pre-resection material, were assessed in seven intrathoracic cases from five males and two females with a median age of 38years. Clinical symptoms were related to mass location, six cases presenting within central and/or posterior mediastinal compartments and one within the lungs. Positron emission tomography-computed tomography demonstrated marked fluoro-deoxy-glucose avidity and the prominent vessels traversing the lesions. Four of six cases (67%) were misdiagnosed initially. HVCD was present in three cases. Two cases with high mitotic rates recurred after resection. All were positive for at least one of the follicular dendritic cell markers (CD21, CD35 and CD23). Six of seven cases (86%) show cyclin D1 expression ranging from 5% to 90%. Follicular dendritic cell sarcoma is often misdiagnosed on biopsy and pathologists need to be aware of the tumour to request the relevant immunohistochemistry, especially in masses presenting in the central/posterior mediastinum with high vascularity and standardized uptake values. Background HVCD appears more common than previously thought.

SU‐C‐207A‐07: Cumulative 18F‐FDG Uptake Histogram Relative to Radiation Dose Volume Histogram of Lung After IMRT Or PSPT and Their Association with Radiation Pneumonitis

Purpose:To determine whether the difference in cumulative 18F‐FDG uptake histogram of lung treated with either IMRT or PSPT is associated with radiation pneumonitis (RP) in patients with inoperable stage II and III NSCLC.Methods:We analyzed 24 patients from a prospective randomized trial to compare IMRT (n=12) with vs. PSPT (n=12) for inoperable NSCLC. All patients underwent PET‐CT imaging between 35 and 88 days post‐therapy. Post‐treatment PET‐CT was aligned with planning 4D CT to establish a voxel‐to‐voxel correspondence between post‐treatment PET and planning dose images. 18F‐FDG uptake as a function of radiation dose to normal lung was obtained for each patient. Distribution of the standard uptake value (SUV) was analyzed using a volume histogram method. The image quantitative characteristics and DVH measures were correlated with clinical symptoms of pneumonitis.Results:Patients with RP were present in both groups: 5 in the IMRT and 6 in the PSPT. The analysis of cumulative SUV histograms showed significantly higher relative volumes of the normal lung having higher SUV uptake in the PSPT patients for both symptomatic and asymptomatic cases (VSUV=2: 10% for IMRT vs 16% for proton RT and VSUV=1: 10% for IMRT vs 23% for proton RT). In addition, the SUV histograms for symptomatic cases in PSPT patients exhibited a significantly longer tail at the highest SUV. The absolute volume of the lung receiving the dose &gt;70 Gy was larger in the PSPT patients.Conclusion:18F‐FDG uptake – radiation dose response correlates with RP in both groups of patients by means of the linear regression slope. SUV is higher for the PSPT patients for both symptomatic and asymptomatic cases. Higher uptake after PSPT patients is explained by larger volumes of the lung receiving high radiation dose.

SU‐F‐J‐95: Impact of Shape Complexity On the Accuracy of Gradient‐Based PET Volume Delineation

Purpose:Explore correlation of tumor complexity shape with PET target volume accuracy when delineated with gradient‐based segmentation tool.Methods:A total of 24 clinically realistic digital PET Monte Carlo (MC) phantoms of NSCLC were used in the study. The phantom simulated 29 thoracic lesions (lung primary and mediastinal lymph nodes) of varying size, shape, location, and 18F‐FDG activity. A program was developed to calculate a curvature vector along the outline and the standard deviation of this vector was used as a metric to quantify a shape's “complexity score”. This complexity score was calculated for standard geometric shapes and MC‐generated target volumes in PET phantom images. All lesions were contoured using a commercially available gradient‐based segmentation tool and the differences in volume from the MC‐generated volumes were calculated as the measure of the accuracy of segmentation.Results:The average absolute percent difference in volumes between the MC‐volumes and gradient‐based volumes was 11% (0.4%–48.4%). The complexity score showed strong correlation with standard geometric shapes. However, no relationship was found between the complexity score and the accuracy of segmentation by gradient‐based tool on MC simulated tumors (R2 = 0.156). When the lesions were grouped into primary lung lesions and mediastinal/mediastinal adjacent lesions, the average absolute percent difference in volumes were 6% and 29%, respectively. The former group is more isolated and the latter is more surround by tissues with relatively high SUV background.Conclusion:The complexity shape of NSCLC lesions has little effect on the accuracy of the gradient‐based segmentation method and thus is not a good predictor of uncertainty in target volume delineation. Location of lesion within a relatively high SUV background may play a more significant role in the accuracy of gradient‐based segmentation.

A non-smooth tumor margin on preoperative imaging predicts microvascular invasion of hepatocellular carcinoma

Microvascular invasion (mVI) is known to be a risk factor of hepatocellular carcinoma (HCC) recurrence. Several factors such as the tumor grade, tumor size, tumor margin status on imaging studies, fluorine-18 fluorodeoxyglucose-positron emission tomography ((18)F-FDG-PET) results, and tumor markers have been proposed to predict mVI of HCC. However, the values of these factors have not yet been validated. Among the patients evaluated using enhanced CT/MRI, (18)F-FDG-PET, and tumor markers prior to hepatectomy from 2007 to 2012, 79 HCC patients without apparent macrovascular invasion in preoperative imaging were enrolled in this study. The image tumor margin status (smooth/non-smooth), (18)F-FDG-PET, and tumor markers, which were previously described as predictors for mVI, were evaluated. Fifteen patients had mVI (mVI+ group) and 64 patients had no evidence of mVI (mVI- group) on pathological examinations. A univariate analysis showed that the mVI+ group had a higher SUV and TNR (5.2 vs 3.8, p=0.02 and 1.8 vs 1.3, p=0.02, respectively) and a higher portion of non-smooth tumor margin (87 vs 27%, p=0.0001). There was no significant difference in the tumor markers. A multivariate analysis showed that non-smooth tumor margin alone could independently predict mVI (odds ratio 18.3, 95% CI 3.27-102.6, p=0.0009). A non-smooth tumor margin on preoperative imaging predicts microvascular invasion of HCC.

Combining standardized uptake value of FDG-PET and apparent diffusion coefficient of DW-MRI improves risk stratification in head and neck squamous cell carcinoma.

To assess the independent prognostic value of standardized uptake value (SUV) and apparent diffusion coefficient (ADC), separately and combined, in order to evaluate if the combination of these two variables allows further prognostic stratification of patients with head and neck squamous cell carcinomas (HNSCC). Pretreatment SUV and ADC were calculated in 57 patients with HNSCC. Mean follow-up was 21.3months. Semiquantitative analysis of primary tumours was performed using SUVmaxT/B, ADCmean, ADCmin and ADCmax. The prognostic value of SUVmaxT/B, ADCmean, ADCmin and ADCmax in predicting disease-free survival (DFS) was evaluated with log-rank test and Cox regression models. Patients with SUVmaxT/B ≥5.75 had an overall worse prognosis (p = 0.003). After adjusting for lymph node status and diameter, SUVmaxT/B and ADCmin were both significant predictors of DFS with hazard ratio (HR) = 10.37 (95% CI 1.22-87.95) and 3.26 (95% CI 1.20-8.85) for SUVmaxT/B ≥5.75 and ADCmin ≥0.58 × 10-3 mm2/s, respectively. When the analysis was restricted to subjects with SUVmaxT/B ≥5.75, high ADCmin significantly predicted a worse prognosis, with adjusted HR = 3.11 (95% CI 1.13-8.55). The combination of SUVmaxT/B and ADCmin improves the prognostic role of the two separate parameters; patients with high SUVmaxT/B and high ADCmin are associated with a poor prognosis. • High SUV maxT/B is a poor prognostic factor in HNSCC • High ADC min is a poor prognostic factor in HNSCC • In patients with high SUV maxT/B , high ADC min identified those with worse prognosis.

18F-FDG-PET/CT therapy assessment of locally advanced pancreatic adenocarcinoma: impact on management and utilization of quantitative parameters for patient survival prediction.

This study aims to evaluate the impact of therapy assessment PET/computed tomography (CT) scan on the management of locally advanced pancreatic adenocarcinoma (LAPC), and the value of qualitative versus quantitative PET/CT interpretation for patient outcome prediction. Forty-two LAPC patients were retrospectively included. PET/CT was performed at a median of 4.6 weeks after completion of chemo ± radiotherapy to assess the primary treatment response. PET was interpreted visually using a qualitative five-point scale (Hopkins criteria for therapy assessment). Quantitative PET parameters including maximum and peak standardized uptake value (SUV max and SUV peak), total lesion glycolysis, and metabolic tumor volume (MTV) were also measured using the gradient segmentation method. Kaplan-Meier and Cox regression analyses were performed. Thirty-five patients were followed up until death. Therapy assessment PET/CT led to a change in the overall management of 22 (52.4%) patients, prompting surgical resection (eight patients), adding radiation therapy (eight patients), or starting palliative chemotherapy (six patients). The median survival in patients with a negative or a positive PET scan, according to the Hopkins criteria, was 14.6 and 8.7 months, respectively (P=0.06). The median quantitative thresholds of SUV peak 2.64 [hazard ratio (HR)=2.67, P=0.03], total lesion glycolysis 44.0 g (HR=2.64, P=0.005), and MTV 24.7 ml (HR=2.57, P=0.008) were significant predictors of overall survival. Using combined quantitative scoring, patients with high SUV peak and high MTV (>median cut point) had a 5.45-fold (95% confidence interval: 1.76-16.87) increased risk for death compared with those with both low SUV peak and MTV (the reference group). PET-based volumetric parameters can predict survival outcomes of patients with LAPC. A combined quantitative PET/CT scoring system provides significantly improved prognostication.

Abstract P5-01-10: Correlation of apparent diffusion coefficient with standardized uptake value in invasive lobular carcinoma of breast using in hybrid 18F-FDG PET/MR

Abstract Purpose: To compare the apparent diffusion coefficient (ADC) with maximum standardized uptake values (SUV) derived from combined 18F-FDG PET/MRI in invasive lobular carcinoma (ILC) patients. Methods: From 2012 Aug to 2015 Feb, 53 women with histologically proven ILC (mean age, 50.3 ± 7.7 y-o) underwent hybrid 18F-FDG PET/MR (Siemens Biograph mMR) scan for preoperative assessment. During PET acquisition, simultaneous diffusion-weighted imaging (DWI, b values: 0, 400, 800 s/mm2) was performed using breast coil. ILC over than 2 Cm in size were analyzed. Regions of interest (ROI) were drawn covering the entire ILC on the attenuation-corrected PET-image and the monoexponential ADC-map on PET/MR workstation. All the patients were received surgical treatment within 3 weeks after scan. Spearman rank correlation coefficient (ρ) was calculated to examine the correlation between SUVmax and ADC value. Results: Total 25 ILC (5.4±1.3 cm; 2.1-6.3 cm) of 22 women were enrolled. 24 ILC showed ER (+)/PR (+) and all ILC showed HER2 (-). 15 patients were confirmed metastatic axillary lymph nodes. The mean of SUVmax was 2.14 ± 2.2 (0.91-11.9) and mean of ADC was 1.02 ×10-3 (0.82 -1.31 ×10-3) mm2/s. Higher histologic grade was correlated with higher SUV (ρ = -0.6, p=0.001). And SUV showed inverse correlation with ADC (ρ = -0.48, p=0.016). Conclusion: The present data show inverse correlation between increased glucose-metabolism and cellularity in ILC patients. 18F-FDG PET and DWI thus may offer complementary information for the evaluation of treatment response in ILC. Citation Format: Choi JE, Kang SH, Lee SJ, Kong EJ. Correlation of apparent diffusion coefficient with standardized uptake value in invasive lobular carcinoma of breast using in hybrid 18F-FDG PET/MR. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-01-10.

Pretreatment Dynamic Contrast-Enhanced MRI Improves Prediction of Early Distant Metastases in Patients With Nasopharyngeal Carcinoma

The identification of early distant metastases (DM) in patients with newly diagnosed, previously untreated nasopharyngeal carcinoma (NPC) plays an important role in selecting the most appropriate treatment approach. Here, we sought to investigate the predictive value of distinct MRI parameters for the detection of early DM.Between November 2010 and June 2011, a total of 51 newly diagnosed NPC patients were included. All of the study participants were followed until December 2014 at a single institution after completion of therapy. DM was defined as early when they were detected on pretreatment FDG-PET scans or within 6 months after initial diagnosis. The following parameters were tested for their ability to predict early DM: pretreatment FDG-PET standardized uptake value (SUV), MRI-derived AJCC tumor staging, tumor volume, and dynamic contrast-enhanced (DCE) values. The DCE-derived ve was defined as the volume fraction of the extravascular, extracellular space.Compared with patients without early DM, patients with early DM had higher SUV, tumor volume, DCE mean (median) ve, ve skewness, ve kurtosis, and the largest mean ve selected among sequential slices (P < 0.05). No differences were identified when early DM were defined only according to the results of pretreatment FDG-PET. Among different quantitative DCE parameters, the mean ve had the highest area under curve (AUC, 0.765). However, the AUCs of SUV, tumor volume, mean ve, ve skewness, ve kurtosis, or the largest mean ve selected among the sequential slices did not differ significantly from one another (P = 0.82).Taken together, our results suggest that DCE-derived ve may be a useful parameter in combination with SUV and tumor volume for predicting early DM. Dynamic contrast-enhanced MRI may be complementary to FDG-PET for selecting the most appropriate treatment approach in NPC patients.

A new assessment model for tumor heterogeneity analysis with [18]F-FDG PET images.

It has been shown that the intratumor heterogeneity can be characterized with quantitative analysis of the [18]F-FDG PET image data. The existing models employ multiple parameters for feature extraction which makes it difficult to implement in clinical settings for the quantitative characterization. This article reports an easy-to-use and differential SUV based model for quantitative assessment of the intratumor heterogeneity from 3D [18]F-FDG PET image data. An H index is defined to assess tumor heterogeneity by summing voxel-wise distribution of differential SUV from the [18]F-FDG PET image data. The summation is weighted by the distance of SUV difference among neighboring voxels from the center of the tumor and can thus yield increased values for tumors with peripheral sub-regions of high SUV that often serves as an indicator of augmented malignancy. Furthermore, the sign of H index is used to differentiate the rate of change for volume averaged SUV from its center to periphery. The new model with the H index has been compared with a widely-used model of gray level co-occurrence matrix (GLCM) for image texture characterization with phantoms of different configurations and the [18]F-FDG PET image data of 6 lung cancer patients to evaluate its effectiveness and feasibility for clinical uses. The comparison of the H index and GLCM parameters with the phantoms demonstrate that the H index can characterize the SUV heterogeneity in all of 6 2D phantoms while only 1 GLCM parameter can do for 1 and fail to differentiate for other 2D phantoms. For the 8 3D phantoms, the H index can clearly differentiate all of them while the 4 GLCM parameters provide complicated patterns in the characterization. Feasibility study with the PET image data from 6 lung cancer patients show that the H index provides an effective single-parameter metric to characterize tumor heterogeneity in terms of the local SUV variation, and it has higher correlation with tumor volume change after radiotherapy (R2 = 0.83) than the 4 GLCM parameters (R2 = 0.63, 0.73, 0.59 and 0.75 for Energy, Contrast, Local Homogeneity and Entropy respectively). The new model of the H index has the capacity to characterize the intratumor heterogeneity feature from 3D [18]F-FDG PET image data. As a single parameter with an intuitive definition, the H index offers potential for clinical applications.

Prognostic significance of parameters from pretreatment (18)F-FDG PET in hepatocellular carcinoma: a meta-analysis.

The prognostic value of (18)F-deoxyglucose positron emission tomography ((18)F-FDG PET) on hepatocellular carcinoma (HCC) remains inconclusive. This study aims to investigate the prognostic role of pretreatment (18)F-FDG PET on HCC patients by meta-analysis. PubMed, Embase, Cochrane library, and Wanfang databases were searched until June 2015. Hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were synthesized by Stata 10.0, and the combined results were used as effective values. Twenty-two studies containing a total of 1721 patients were identified. According to random-effect model, meta-analysis results showed that high Tumor SUV/Liver SUV (Tsuv/Lsuv) ratio was significantly associated with poorer overall survival (OS) (HR = 2.04; 95% CI 1.50-2.79; P = 0.000) and poorer disease-free survival (HR = 7.17; 95% CI 3.58-14.36; P = 0.000); and high Tumor SUV (Tsuv) value was also correlated with poor OS (HR = 1.53; 95% CI 1.26-1.87; P = 0.000). Meanwhile, subgroup analysis results showed that the significant association above was not altered by study sample size, parameter cutoff value, analytic method, and follow-up period, but there was no significant association between Tsuv/Lsuv ratio and OS in patients who underwent resection (HR = 1.71; 95% CI 1.00-2.92; P = 0.052). Both high Tsuv/Lsuv ratio and high Tsuv value are associated with poor prognosis in HCC patients. Therefore, pretreatment (18)F-FDG PET is a useful tool in predicting the prognosis of HCC patients. More studies with explicit treatment modalities are required to investigate the prognostic value of pretreatment (18)F-FDG PET on HCC patients.

Suvmax in 18-Fluorodeoxyglucose PET/CT Potentially Predict the Estimation of a Positive Biopsy in Cases of Lymphoma

IntroductionThe significance of 18-fluorodeoxyglucose PET/CT for predicting the estimation of a positive biopsy in cases of lymphoma is unknown. Diagnosis of lymphoma is based on a lymph node biopsy, however, the use of 18-fluorodeoxyglucose PET/CT for selecting a biopsy site that would provide the best the yield for accurate diagnosis remains unknown.Patients and MethodsData on 165 patients with initial suspicion of lymphoma that underwent PET/CT scans and biopsy as part of their initial evaluation were prospectively collected and reviewed. Standadized uptake value (SUVmax) of the biopsy site and others was collected from radiology reports. The association between the SUVmax on FDG-PET/CT before excision and the estimation of lymphoma diagnosis at biopsy was examined using a receiver operating characteristics curve analysis (ROC).Results159/165 (84.5%) cases suspected of lymphoma underwent PET/CT scan performed prior excisional/FNA biopsy. Ninety six cases were diagnosed of diffuse large B cell lymphoma (DLBCL), 24 follicular lymphoma, 34 Hodgkin lymphoma, 15 plasmablastic lymphomas, and 6 marginal zone lymphoma. Receiver operating characteristics curve analysis demonstrated an area under the curve (AUC) of 0.6 with a borderline p-value of 0.06, which reached level of significance when the methodology of diagnosis only involved fine needle aspiration (FNA, AUC: 0.645, p= 0.05) or when the analysis was performed in patients with a diagnosis of follicular lymphoma (AUC:0.8, p<0.05). We identified several factors that influence SUVmax intensity, which included lymphoma subtype, stage and LDH. Consistent with prior reviews, tumor type was associated with higher SUVmax withDLBCL and plasmablastic with the highest SUV, followed by Hodgkin lymphoma and low grade lymphoma (p<0.05). Tumors with advance stage (stage 4) and high LDH levels were also associated with higher SUVmax.ConclusionSUVmax on FDG-PET/CT is potentially useful for guiding biopsy sites that will provide the best yield to diagnose lymphoma. SUVmax is particularly useful to diagnose lymphoma when FNA is performed as diagnostic procedure of choice. We identified that tumor type, stage and LDH can affect SUV intensity. Performing a Receiver operating characteristics curve analysis of the SUVmax on FDG-PET/CT in a larger samples size is warranted for defining thresholds that predict the estimation of a positive biopsy. DisclosuresCohen:Celgene, Pharmacyclics, Millennium, Seattle Genetics: Consultancy; BMS, Janssen: Research Funding. Flowers:TG Therapeutics: Research Funding; Seattle Genetics: Consultancy; Acerta: Research Funding; Pharmacyclics: Research Funding; Spectrum: Research Funding; Genentech: Research Funding; Onyx Pharmaceuticals: Research Funding; Takeda: Research Funding; AbbVie: Research Funding; Infinity Pharmaceuticals: Research Funding; Gilead Sciences: Research Funding; Celgene: Research Funding; OptumRx: Consultancy; Janssen: Research Funding. Bernal-Mizrachi:Takeda: Research Funding; Empire Genomics: Consultancy, Patents & Royalties.

Association between [18F]-fluoro-2-deoxyglucose uptake and expressions of hypoxia-induced factor 1α and glucose transporter 1 in non-small cell lung cancer

High maximal standardized uptake values (SUVmax) on [18F]-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) are associated with inferior survival in non-small cell lung cancer (NSCLC).

Prognostic significance of (18)FDG PET/CT in colorectal cancer patients with liver metastases: a meta-analysis.

BackgroundThe role of 18-fluorodeoxyglucose positron emission tomography CT (18FDG PET/CT), as a prognostic factor for survival in colorectal cancer patients with liver metastases, is still controversial. We sought to perform a meta-analysis of the literature to address this issue.MethodsA systematic literature search was performed to identify the studies that associated 18FDG PET/CT to clinical survival outcomes of patients with liver metastases. Methodological qualities of the included studies were also assessed. The summarized hazard ratio (HR) was estimated by using fixed- or random-effect model according to heterogeneity between trails.ResultsBy analyzing a total of 867 patients from 15 studies, we found that PET/CT for metabolic response to the therapy was capable of predicting event-free survival (EFS) and overall survival (OS) with statistical significance, and the HR was 0.45 (95 % confidence interval [CI], 0.26–0.78) and 0.36 (95 % CI, 0.18–0.71), respectively. Furthermore, pre-treatment 18FDG PET/CT with high standardized uptake value (SUV) was also significantly associated with poorer OS HR, 1.24; (95 % CI, 1.06–1.45). However, we did not find a statistically significant effect of post-treatment SUV for predicting OS HR, 1.68; (95 % CI, 0.63–4.52).ConclusionsThe present meta-analysis confirms that 18FDG PET/CT is a useful tool to help predict survival outcomes in patients with liver metastases.Electronic supplementary materialThe online version of this article (doi:10.1186/s40644-015-0055-z) contains supplementary material, which is available to authorized users.