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Objective:To investigate the correlation between KRAS, NRAS and BRAF V600E gene mutations and the clinicopathological characteristics of patients with colorectal cancer.Methods:Specimens from 217 patients with colorectal cancer who underwent surgical resection and were pathologically confirmed in Shanxi Province Cancer Hospital from January 2020 to December 2021 were selected, and the clinical data of the patients were retrospectively analyzed. The mutation status of KRAS, NRAS and BRAF V600E genes were detected in the paraffin specimens of surgically-resected tissues by direct sequencing. The mutation rates of KRAS, NRAS and BRAF V600E were compared among patients with different clinicopathological characteristics.Results:The mutation rates of KRAS, NRAS and BRAF V600E in 217 patients with colorectal cancer were 48.4% (105/217), 4.1% (9/217) and 3.7% (8/217), of which 1 patient (0.5%) had both KRAS and NRAS mutations. NRAS gene mutation was not correlated with gender, age, tumor size, tumor location, pathological type, degree of differentiation, depth of invasion, lymph node metastasis, distant metastasis, TNM stage, hemangioma thrombus/nerve invasion (all P>0.05); KRAS mutation rate in patients ≥ 60 year old was higher than that in patients < 60 year old [55.3% (63/114) vs. 40.8% (42/103), χ2 = 4.55, P = 0.033),and there was no correlation between KRAS gene mutation and other clinicopathological features (all P > 0.05); the mutation rate of BRAF V600E gene in colorectal cancerpatients with distant metastasis was higher than that in patients without distant metastasis [16.7% (4/24) vs. 2.1% (4/193), P = 0.006], and there was no correlation between BRAF V600E gene mutation and other clinicopathological features (all P > 0.05). Conclusions:Older colorectal cancer patients may be prone to KRAS gene mutation, and the BRAF V600E gene mutation rate is higher in patients with distant metastasis, and there is no correlation between NRAS gene mutation and clinicopathological characteristics.
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Nutrition therapy is considered as the basis for prevention and management of chronic kidney disease (CKD), throughout the three-tier prevention strategies of CKD. The primary objective is to delay the disease progression, correct metabolic disorders, and improve the outcomes of CKD. Low protein diet has been recognized as an important therapeutic measure in CKD, but the quantity, quality and source of protein are always the points of contention. Recently, both domestic and foreign guidelines have been updated on the amount of protein intake. In addition to quantity, attention has been paid to the type and diversity of proteins. With the rise of plant-based food consumption and the concept of vegetarian diet, the scientific community began to review the benefits of plant protein again, and a plant-based diet is recommend extensively. Whether the plant-based dietary pattern is also suitable for CKD patients who need a low-protein diet, and whether it could meet the nutritional needs of CKD patients are hot topics, this article reviews the recent progress of these research hotspots.
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Objective:To evaluate the value of 18F-FDG uptake features in differential diagnosis of benign and malignant solitary pulmonary lesions. Methods:A total of 274 patients (181 males, 93 females, age: (61.0±10.2) years) with solitary pulmonary lesions who underwent 18F-FDG PET/CT between September 2010 and March 2017 were retrospectively analyzed. The 18F-FDG uptake features of lesions were divided into 5 types: full uptake (Group A), circular uptake (Group B), multi-focus uptake (Group C), mild uptake (Group D) and no-uptake (Group E). According to the pathology or follow-up results, the incidences of benign and malignant lesions in each group were analyzed. The diagnostic efficiencies of 18F-FDG uptake feature classification(A+ B=malignancy, C+ D+ E=benign) and SUV method (lesions with SUV max≥2.5 was taken as the malignancy) were calculated. χ2 test and ROC curve were used to analyze the data. Results:The malignant incidences of Groups A-E were 86.25%(138/160), 71.05%(27/38), 31.25%(10/32), 43.48%(10/23) and 14.29%(3/21), respectively ( χ2=79.49, P<0.001), and the rate of Group A was the highest ( χ2 values: 5.11-55.84, all P<0.05). There were significant differences in the malignancy incidence between A+ B group and C+ D+ E group (83.33%(165/198) vs 30.26%(23/76)), and between SUV max≥2.5 group and SUV max<2.5 group (76.09%(175/230) vs 29.55%(13/44); χ2 values: 71.83 and 37.15, both P<0.001). The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the 18F-FDG uptake feature classification and the SUV method were 87.77%(165/188) vs 93.09%(175/188), 61.63%(53/86) vs 36.05%(31/86), 79.56%(218/274) vs 75.18%(206/274), 83.33%(165/198) vs 76.09%(175/230), 69.74%(53/76) vs 70.45%(31/44), respectively. ROC curve analysis showed that the diagnostic accuracy of the 18F-FDG uptake feature classification was higher than that of SUV method (AUCs: 0.747, 0.646; Z=4.05, P<0.001). Conclusions:18F-FDG uptake feature classification can improve the diagnostic specificity and accuracy of solitary pulmonary lesions. The multi-focus uptake feature maybe a sign of benign lesions, which still needs more researches to confirm.
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Objective:To investigate the value of 18F-prostate specific membrane antigen (PSMA)-1007 PET/CT in the detection of prostate cancer recurrence at low serum prostate specific antigen (PSA) level. Methods:From July 2018 to June 2019, 45 patients (age: 59-74 years) with suspected biochemical recurrence of prostate cancer with low PSA level (<2.0 μg/L) who underwent 18F-PSMA-1007 PET/CT examinations in Shanxi Tumor Hospital were retrospectively analyzed. Four patients with PSA<0.2 μg/L were not included in the statistical analysis due to the small sample. Among the remaining 41 patients with 0.2 μg/L≤PSA<2.0 μg/L, 10 were with 0.2 μg/L≤PSA<0.5 μg/L, 14 were with 0.5 μg/L≤PSA<1.0 μg/L, 17 were with 1.0 μg/L≤PSA<2.0 μg/L. PET/CT imaging were performed within 2 weeks after the examination of serum PSA. All patients were divided into low-moderate-risk group ( n=12) and high-risk group ( n=29) according to the National Comprehensive Cancer Network (NCCN) guidelines. χ2 test, Fisher′s exact test and Spearman rank correlation were used to analyze the data. Results:Patients were followed up for 7 (4-15) months, and all 45 patients were confirmed by pathology or follow-up. There were 31 patients with recurrence and 14 patients without recurrence. The sensitivity, specificity and accuracy were 100%(31/31), 13/14, 97.78%(44/45)respectively. One patient with PSA<0.2 μg/L presented retroperitoneal lymph node metastasis. Among 41 patients with 0.2 μg/L≤PSA<2.0 μg/L, 31(75.61%) were with at least one recurrent lesion by 18F-PSMA-1007 PET/CT. There were 20 cases of local recurrence, 13 cases of lymph node metastasis, 14 cases of bone metastasis. The detection efficacies of 18F-PSMA-1007 PET/CT were 5/10 for patients with 0.2 μg/L≤PSA<0.5 μg/L, 11/14 for those with 0.5 μg/L≤PSA<1.0 μg/L, and 15/17 for those with 1.0 μg/L≤PSA<2.0 μg/L ( χ2=4.641, P>0.05). The positive results of 18F-PSMA-1007 PET/CT were positively correlated with serum PSA value and risk group ( r values: 0.394, 0.384, both P<0.05). Conclusion:18F-PSMA-1007 PET/CT is a valuable tool for detecting biochemical recurrence of prostate cancer with low PSA level.
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Objective To evaluate the prognostic value of the maximum standardized uptake value decrease proportion (△SUVmax％) on 18F-fluorodeoxyglucose (FDG) PET/CT imaging and C-MYC gene in diffuse large B cell lymphoma (DLBCL),and to find the optimal time of PET/CT imaging.Methods From September 2010 to February 2016,171 patients (87 males,84 females,average age:(50.66±2.56) years)with pathologically confirmed DLBCL were analyzed.18F-FDG PET/CT were performed before and after different courses of chemotherapy (60 patients in early phase which means 1 and 2 courses;55 patients in medium phase,3 and 4 courses;56 patients in late phase,5 and 6 courses).The region of interest (ROI) was drawn and the △SUVmax％ was calculated.Patients were evaluated with Deauville 5-point scale.Fluorescence in situ hybridization (FISH) was employed to detect C-MYC gene.Patients were followed up for 6-71 months,and progression-free survival (PFS) was calculated.x2 test,one-way analysis of variance,Kaplan-Meier analysis and Spearman correlation analysis were used to analyze the data.Results There were 42 C-MYC gene rearrangement of 171 DLBCL patients.Age,Ann Arbor stage,international prognostic index (IPI) score,serum lactate dehydrogenase (LDH) level and therapeutic response were different between patients with C-MYC gene rearrangement and those without rearrangement (x2:6.139-98.339,all P＜0.05).The optimum cutoff values of the △SUVmax％ were 62.5％,87.0％ and 92.0％ respectively in the early,medium and late phases of chemotherapy.Patients with △SUVmax％ ≥≥ 62.5％,≥ 87.0％ or ≥ 92.0％ and normal C-MYC gene showed longer PFS (x2 values:21.983-61.899,all P＜0.001).The △SUVmax％ was negatively correlated with C-MYC gene rearrangement (rs =-0.801,P ＜ 0.001).Significant differences were found in △SUVmax％ (F=6.509,P＜0.01) and Deauville 5-point scale (F=19.897,P＜0.001) among patients in early,medium and late phases.No Significant differences were shown between medium and late phases (P＞0.05).Conclusion △SUVmax％ in the different phases of chemotherapy and C-MYC gene rearrangemeut have better values for predicting the prognosis of DLBCL,and 18F-FDG PET/CT imaging should be performed between 1 course and 4 courses of chemotherapy.
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Purpose To discuss the diagnostic value and the optimal diagnostic threshold of preoperative 18F-FDG PET/CT imaging on regional lymph node metastasis in colorectal cancer.Materials and Methods Seventy-six patients with newly diagnosed colorectal cancer underwent radical resection of colorectal cancer within one week after PET/CT examination.All lymph nodes matching PET/CT were divided into proximal and distal lymph nodes on the basis of their location relative to the primary tumor.Meanwhile,the receiver operating characteristic (ROC) curves of the lymph node short diameter and maximum standardized uptake value (SUVmax) were created according to the pathological findings which were considered as the gold standard,and the diagnostic efficacies were analyzed.Results The proximal and distal lymph node ROC curves showed that the optimum thresholds of lymph node short diameter,SUVmax were 6.5 mm,1.9 and 5.5 mm,1.81.The sensitivity,specificity and accuracy of the diagnosis of proximal lymph node metastasis under the optimum threshold of lymph node short diameter were 84.85％,73.02％ and 77.52％,respectively;and those of distal lymph node metastasis were 97.62％,65.45％ and 79.38％,respectively.The sensitivity,specificity and accuracy of the diagnosis of proximal lymph node metastasis under the optimum threshold of SUVmax were 84.85％,95.81％ and 91.64％,respectively;those of distal lymph node metastasis were 92.86％,94.55％ and 93.81％,respectively.The specificity and accuracy of the optimum threshold of SUVmax were higher than those of the optimum threshold of lymph node short diameter (P＜0.01).The homogeneity of optimum threshold of SUVmax was excellent in comparison with the pathological results (Kappa=0.813 and 0.874,P＜0.01).Conclusion Optimum threshold method improves the diagnostic efficacy of 18F-FDG PET/CT in regional lymph node metastasis of colorectal cancer.Moreover,the SUVmax standard is superior to lymph node short diameter standard.
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Objective To discuss the value of preoperative 18F-FDG PET-CT imaging in the staging of colorectal cancer. Methods Eighty-three patients with colorectal cancer were studied who underwent 18F-FDG PET-CT examinations without any previous treatment and subsequent operations within one week. The results of PET-CT and pathology were analyzed with chi-square test and Kappa consistency test. Results The diagnostic accuracy of primary colorectal lesions was 100 %, the average of maximum standardized uptake value(SUVmax) was 14.54±8.10(4.43-48.19). The diagnostic accuracy of local infiltration depth, lymph node metastasis, distant metastasis and TNM staging before operation were 73.49 %(61/83), 90.36 %(75/83), 97.59 % (81/83) and 85.54 % (71/83), respectively, and the Kappa values were 0.481, 0.797, 0.950, 0.788 (P <0.05).The diagnostic sensibility of staging with T1-2,T3and T4were 30.00 %(3/10),68.42 %(13/19) and 83.33 % (45/54), respectively, the diagnostic accuracy of staging with T1-2, T3and T4were 91.57 % (76/83), 74.70 % (62/83) and 80.72 % (67/83). Conclusion Preoperative 18F-FDG PET-CT imaging is an effective staging method for colorectal cancer, and has high accuracy in the detection of primary colorectal lesions, lymph node metastasis, distant metastasis and T4stage lesions, but it is difficult for diagnosing of the T1-2and T3lesions.
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Objective:The relationship between the effect of early metabolism in 18F-FDG PET/CT and conventional CT based on the RE-CIST standard to evaluate the best objective response after chemotherapy in patients with non-small cell lung cancer (NSCLC). Meth-ods:We studied 40 patients with unresectable locally advanced or advanced NSCLC that were confirmed pathologically. The patients were 35 years old to 78 years old and included 31 males and 9 females. Three patients have unresectable stageⅢA, 8 patients have stageⅢB, 29 patients have stageⅣ, 12 patients have squamous cell carcinoma, and 28 patients have adenocarcinoma. The PET/CT for the effect of chemotherapy was evaluated in NSCLC according to the SUV standard (SUVmax reduction>30%of primary lung can-cer after one cycle of chemotherapy), and the CT for the effect of chemotherapy was evaluated on the basis of NSCLC according to the RECIST standard. The objectives of the study are as follows:compare the differences and consistency between 18F-FDG PET/CT metabol-ic response after the first cycle of chemotherapy and the RECIST best objective response after the first or second cycle of chemothera-py with the paired chi-square test and kappa test;calculate the 18F-FDG PET/CT to predict the best objective response of two cycles of chemotherapy according to RECIST on the basis of NSCLC in terms of sensitivity, specificity, accuracy, positive predictive value, and neg-ative predictive value;compare the differences in SUVmax reduction between the metabolic remission group and metabolic no relief group with the two-sample t-test. All statistical methods were 0.05 for the inspection level, and P<0.05 was considered statistically sig-nificant difference (SPSS19.0). Results:Differences were found between the first cycle of chemotherapy for the RECIST best objective response and 18F-FDG PET/CT metabolic response (χ2=5.063, P=0.021), and the results had bad consistency (Kappa=0.240, P=0.085). No differences were observed between the second cycle of chemotherapy for the RECIST best objective response and 18F-FDG PET/CT metabolic response (χ2=2.083, P=0.146);the results had good consistency (Kappa=0.413, P=0.006). The sensitivity, specificity, accura-cy, positive predictive value, and negative predictive value were 82%, 61%, 70%, 61%, and 82%, respectively. The differences in SUV-max reduction between the metabolic remission group and metabolic no relief group with the two-sample t-test were statistically sig-nificant (P<0.001). Conclusion: 18F-FDG PET/CT may predict the best objective response to chemotherapy for NSCLC patients. Com-pared with conventional CT, 18F-FDG PET/CT can be an early and accurate way to evaluate the chemotherapy effect in NSCLC.
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Objective To evaluate the value of 18F-FDG PET/CT in early in vivo monitoring of tumor response to cisplatin,and analyze the relationship between 18F-FDG uptake in tumor and the corresponding pathological changes.Methods Thirty VX2 rabbits were divided into 5 groups by random number table with 6 in each group,including 4 treatment groups and 1 control group.18F-FDG PET/CT were performed before and after (6,12,24 and 36 h post-injection respectively) intravenous administration of cisplatin (7 mg/kg) in the treatment groups,respectively.The control group was injected with physiological saline followed by 18F-FDG PET/CT.The ROI was drawn and the SUVmax and T/NT ratio were calculated.The tumor necrosis rate and apoptosis index were observed by histopathologic examination.Paired t test,GamesHowell test and arcuation correlation analysis were used to analyze the data.Results Significant differences were found in SUVmax and T/NT of the control group before and after injection of physiological saline (6.58±1.67 vs 9.77±2.45,52.93±3.90 vs 29.34±3.31;t=-5.480,17.593,both P＜0.05).18F-FDG uptake decreased after 6 h post-injection of cisplatin,with the mean SUVmax decrease rate of (11.83±8.89) ％ and the mean T/NT decrease rate of (59.00±8.22)％.In the 24 h treatment group,18F-FDG uptake decreased most,and the mean SUVmax decrease rate was (42.33±33.80)％,the mean T/NT decrease rate was (83.50± 7.69) ％.The SUVmax and T/NT of those 2 groups were significantly different from those of the control group,and no difference was found between the 2 treatment groups(all P＜0.05).The changes of SUVmax and T/NT were positively correlated with apoptosis index and tumor necrosis rate (r=0.750,0.794,0.804,0.874,all P＜0.05).Conclusion 18F-FDG PET/CT is a sensitive method for monitoring early response to tumor chemotherapy in VX2 tumor-bearing rabbits at 24 h after treatment.
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Objective Currently,pediatric 18F-FDG dose and acquisition durations are generally based on coarse extrapolation from adult guidelines.This study sought to determine whether shorter acquisition durations or a lower 18F-FDG injected activity could be used during pediatric 18F-FDG PET/CT examinations while maintaining diagnostic utility.Methods Thirty-six whole-body 18F-FDG PET/CT examinations were performed on 36 patients (weight,13-89 kg,(46.51±5.63) kg; age range,3-14 years old,(9.22±3.16) years old) with a weight-based injected activity (5.3 MBq/kg (0.144 mCi/kg)),fixed acquisition durations 180 S/FOV,VIP record acquisition mode using Discovery STE.For each examination,the Vip-mode data was truncated to form multiple datasets with shorter acquisition durations down to a minimum of 60 s/FOV (i.e.,60,80,100,120,140,160 s/FOV data were formed from single 180 s/FOV acquisition).168 image volumes were generated,randomized,and reviewed in a masked manner with corresponding CT image volumes by 6 radiologists.Overall,subjective adequacy and objective lesion detection accuracy by body region were evaluated.Results All examinations with maximum acquisition duration were graded as adequate and were used as the reference standard for detection accuracy.For patients more than 30 kg,when acquisition duration was more than 120 s/FOV,all PET/CT examinations were graded as adequate for clinical tasks,whereas,when acquisition duration was reduced to less than 120 s/FOV,lesion detection became less accurate.For patients less than 30 kg,lesion detection accuracy was perfect for acquisition times between 140 s/FOV and 180 s/FOV for all regions of the body.However,lesion detection became less accurate when imaging acquisition time was reduced less than 140 s/FOV.Conclusions When GE Discovery STE PET/CT was applied during pediatric PET/CT examination,using decreased acquisition times as a surrogate for 18F-FDG dose,18F-FDG dose can be reduced by approximately 33.33％ when patients weigh over 30 kg were scanned for 180 s/FOV.For patients less than 30 kg,18F-FDG dose can be reduced by approximately 22.22％ without losing diagnostic quality.Reduction of overall scan time potentially reduces motion artifacts,improves patient comfort,and decreases length of sedation.Alternatively,decreased 18F-FDG dose minimizes radiation risk.