The Synergy of 177Lu-FAPI-046 with Tyrosine Kinase Inhibitor in a Sarcoma Patient-Derived Xenograft Mouse Model.

BACKGROUND: Given the heterogeneity and high mortality associated with metastatic soft tissue sarcoma, this study aims to evaluate the therapeutic efficacy of combining 177Lu-FAPI-46 with Pazopanib against this malignancy. METHODS: Patient-derived xenograft (PDX)-bearing mice were randomly divided into three groups: the control group, the 177Lu-FAPI-46 monotherapy group, and the 177Lu-FAPI-46 combined with Pazopanib therapy group. Therapeutic efficacy was regularly monitored. RESULTS: The microPET imaging showed a 0.84-fold decrease in the T/M ratio of 68Ga-FAPI-46 on day 7/8 post combination therapy, while the control group exhibited a 1.23-fold increase. Combination therapy significantly inhibited tumor proliferation, as evidenced by reduced Ki-67 and increased caspase 3 expressions. Notably, there was no significant body weight loss observed in any group. CONCLUSION: This study successfully demonstrated the reduction in FAP expression and suppression of tumor volume in sarcoma PDX following the combination therapy of 177Lu-FAPI-46 with Pazopanib.

Feasibility of Recombinant Human TSH as a Preparation for Radioiodine Therapy in Patients with Distant Metastases from Papillary Thyroid Cancer: Comparison of Long-Term Survival Outcomes with Thyroid Hormone Withdrawal.

BACKGROUND: this study was designed to compare the long-term survival outcomes of patients prepared for radioiodine (RAI) therapy using either thyroid hormone withdrawal (THW) or recombinant human thyrotropin (rhTSH) stimulation, by specifically focusing on cases with distant metastases from papillary thyroid cancer (PTC). METHODS: A retrospective analysis was performed on 88 patients with distant metastases from PTC. Fifty-one and thirty-seven patients were prepared for RAI treatment by either THW or rhTSH stimulation, respectively. The primary endpoints were progression-free survival (PFS) and disease-specific survival (DSS). RESULTS: The 10-year DSS rates of patients prepared for RAI therapy using either THW or rhTSH stimulation were 62.2% and 73.3%, respectively. Using multivariate analysis, RAI-avid metastases (p = 0.025) and preparation with rhTSH (p = 0.041) were identified as independent prognostic factors for PFS. Notably, PFS in the group of patients with RAI-avid metastases and preparation with rhTSH was significantly better than that in the other groups (p = 0.025). CONCLUSIONS: Preparation for RAI therapy using rhTSH stimulation is not inferior to THW preparation in terms of long-term survival outcomes experienced by patients with PTC and distant metastasis. Patients with RAI-avid metastases and preparation with rhTSH had the most favorable PFS.

Aspartate and Acetate Fuel Gastrointestinal Stromal Tumors Beyond the Warburg Effect.

Metabolic reprogramming is closely linked to the tumorigenesis and drug resistance of gastrointestinal stromal tumors (GISTs). Mapping the metabolic orbit of GISTs is a prerequisite if intervention against the metabolic vulnerability of refractory GISTs is desirable. Methods: A total of 43 patients with treatment-naïve GISTs who had undergone surgical resections were enrolled, on whom a metabolomics profile detected from surgical specimens was constructed based on the 1H-nuclear magnetic resonance (NMR) platform. The mRNA and protein levels of GLUT1, HK2, ACSS2, and FASN were assayed. Dual-tracer 18F-FDG/11C-acetate PET imaging was introduced before surgery in 15 patients. Results: 1H-NMR-based metabolomics revealed that GISTs were characterized by upregulation of glutamate, ascorbate, aspartate and glycine and downregulation of choline, creatine, glucose and glycerol. Bioinformatics analysis showed that the TCA cycle and alanine, aspartate, and glutamate metabolism were the two leading pathways. High- and nonhigh-risk (including intermediate-, low-, and very low-risk) GISTs preferentially displayed upregulation of HK2 and ACSS2, respectively, echoed by in vivo imaging that high- and nonhigh-risk GISTs preferentially exhibited higher uptake of 18F-FDG and 11C-acetate, respectively, while 18F-FDG and 11C-acetate were complementary to each other. Nuclear ACSS2 was exclusively identified in high-risk GISTs. Conclusion: We describe a metabolic landscape of GISTs that read aspartate as a de facto "oncometabolite," which was replenished via the TCA cycle and alanine, aspartate, and glutamate metabolism. Glycolysis and ACSS2-mediated acetate metabolism competed and complemented fatty acid synthesis, although glycolysis remained an aggressive phenotype.

2021 Advocacy Statements for the Role of 99mTc-Pyrophosphate Scintigraphy in the Diagnosis of Transthyretin Cardiac Amyloidosis: A Report of the Taiwan Society of Cardiology and the Society of Nuclear Medicine of the Republic of China.

Transthyretin cardiac amyloidosis (ATTR-CM) is an increasingly recognized cause of heart failure with preserved ejection fraction. Favorable prognosis depends on early diagnosis and correct treatment strategy. Among patients for whom there is a high clinical suspicion of cardiac amyloidosis, 99mTc-labeled bone avid scintigraphy including 99mTc-pyrophosphate (PYP) scintigraphy may be of diagnostic and prognostic importance. Various international guidelines support the non-biopsy diagnosis of ATTR-CM using 99mTc-PYP scintigraphy, yet emphasize the gap in standardization of acquisition and imaging analysis protocols, as well as the appropriateness of its clinical use. Therefore, a joint expert consensus has been reached by the Taiwan Society of Cardiology and the Society of Nuclear Medicine of the Republic of China, to advocate for the application of 99mTc-PYP scintigraphy in the diagnosis of ATTR-CM. This article aims to highlight the recommendations on image acquisition, qualitative and quantitative assessments of cardiac 99mTc-PYP uptake, and diagnostic algorithms. We hope the implementation of these recommendations in Taiwan will facilitate the process and enhance the diagnostic rate of ATTR-CM.

Prognostic Value and Clinical Impact of Pretreatment FDG PET in Pulmonary Lymphoepithelioma-Like Carcinoma.

PURPOSE: Compared with other forms of non-small cell lung cancer, pulmonary lymphoepithelioma-like carcinoma (LELC) is rarer and portends better outcomes. We sought to investigate the prognostic role and clinical impact of pretreatment F-FDG PET in pulmonary LELC. METHODS: A total of 71 patients with pulmonary LELC were identified through a retrospective review of clinical records. Of them, 41 underwent F-FDG PET for primary staging. Outcomes were assessed using the Kaplan-Meier method and Cox regression models with a forward stepwise selection procedure. Staging changes served as the main outcome measure for assessing the impact of F-FDG PET. For the purpose of analyses, all patients were restaged according the American Joint Committee on Cancer Staging Manual eighth edition. RESULTS: Stage and pretreatment F-FDG PET were significantly independent predictors of overall survival (OS) on multivariate analysis. Five-year OS rates for patients with stages I-II, III-IVA, and IVB were 92.3%, 70.4%, and 20.0%, respectively. The use of F-FDG PET for staging purposes was associated with a better OS (P = 0.003). Specifically, the 5-year OS rates for patients who were staged with and without F-FDG PET were 85.4% and 49.7%, respectively (P = 0.012). F-FDG PET resulted in a disease upstage in 28.6% of patients with CT-defined stages III-IVA; of them, 14.3% were upstaged to IVB disease. CONCLUSIONS: The American Joint Committee on Cancer eighth edition stage and pretreatment F-FDG PET were independent prognostic factors for OS in patients with pulmonary LELC. F-FDG PET imaging resulted in a better disease staging with a corresponding optimization of therapeutic interventions, which ultimately improved survival outcomes.

Prognostic impact of combining whole-body PET/CT and brain PET/MR in patients with lung adenocarcinoma and brain metastases.

PURPOSE: The role of brain FDG-PET in patients with lung cancer and brain metastases remains unclear. Here, we sought to determine the prognostic significance of whole-body PET/CT plus brain PET/MR in predicting the time to neurological progression (nTTP) and overall survival (OS) in this patient group. METHODS: Of 802 patients with non-small cell lung cancer who underwent primary staging by a single-day protocol of whole-body PET/CT plus brain PET/MR, 72 cases with adenocarcinoma and brain metastases were enrolled for a prognostic analysis of OS. On the basis of the available follow-up brain status, only 52 patients were eligible for prognostic analysis of nTTP. Metastatic brain tumors were identified on post-contrast MR imaging, and the tumor-to-brain ratio (TBR) was measured on PET images. RESULTS: Multivariate analysis revealed that FDG-PET findings and eligibility for initial treatment with targeted therapy were significant independent predictors of nTTP and OS. A new index, termed the molecular imaging prognostic (MIP) score, was proposed to define three disease classes. MIP scores were significant predictors of both nTTP and OS (P < 0.001). Pre-existing prognostic indices such as Lung-molGPA scores were significant predictors of OS but did not predict nTTP. CONCLUSIONS: When staging is performed with whole-body PET/CT plus brain PET/MR, our new prognostic index may be helpful to stratify the outcomes of patients with lung adenocarcinoma and brain metastases. The superior prognostic power of this index for nTTP might be used to select appropriate patients for intracranial control and thereby achieve better quality of life.

Presurgical Identification of Uterine Smooth Muscle Malignancies through the Characteristic FDG Uptake Pattern on PET Scans.

The unidentified presence of uterine smooth muscle malignancies poses a tremendous risk in women planning surgery for presumed benign leiomyomas. We sought to investigate whether preoperative FDG PET may be useful to identify leiomyosarcomas (LMS) and smooth muscle tumors of uncertain malignant potential (STUMP). Methods. We investigated patients with rapidly growing uterine masses which were suspected of being malignant on ultrasound or MRI. Among the 21 patients who underwent FDG PET, we identified 7 LMS, 1 STUMP, and 13 leiomyomas. PET-derived parameters and FDG uptake patterns were analyzed retrospectively. Results. The SUVmax values of LMS/STUMP (range: 3.7-11.8) were significantly higher than those observed in leiomyomas (range: 2.0-9.4; P=0.003) despite a significant overlap. The metabolic tumor/necrosis ratio was significantly higher in LMS/STUMP than in leiomyomas (P < 0.001), with no significant intergroup overlaps. All LMS/STUMP revealed a characteristic pattern of FDG uptake, identifying a specific "hollow ball" sign (corresponding to areas of coagulative tumor necrosis). In contrast, this sign was invariably absent in patients with leiomyomas. Conclusion. The characteristic FDG uptake pattern instead of SUV on PET images allows identifying LMS/STUMP in patients with rapidly growing uterine masses, avoiding the deleterious consequences of regular surgery for presumed benign leiomyomas.

Detecting Triple-Vessel Disease with Cadmium Zinc Telluride-Based Single-Photon Emission Computed Tomography Using the Intensity Signal-to-Noise Ratio between Rest and Stress Studies.

The purpose of this study was to investigate if a novel parameter, the stress-to-rest ratio of the signal-to-noise ratio (RSNR) obtained with a cadmium zinc telluride (CZT) SPECT scanner, could be used to distinguish triple-vessel disease (TVD) patients. Methods. One hundred and two patients with suspected coronary artery disease were retrospectively involved. Each subject underwent a Tl-201 SPECT scan and subsequent coronary angiography. Subjects were separated into TVD (n = 41) and control (n = 61) groups based on coronary angiography results using 50% as the stenosis cutoff. The RSNR was calculated by dividing the stress signal-to-noise ratio (SNR) by the rest SNR. Summed scores were calculated using quantitative perfusion SPECT (QPS) for all subjects. Results. The RSNR in the TVD group was found to be significantly lower than that in the control group (0.83 ± 0.15 and 1.06 ± 0.17, resp.; P < 0.01). Receiver-operating characteristic (ROC) analysis showed that RSNR can detect TVD more accurately than the summed difference score with higher sensitivity (85% versus 68%), higher specificity (90% versus 72%), and higher accuracy (88% versus 71%). Conclusion. The RSNR may serve as a useful index to assist the diagnosis of TVD when a fully automatic quantification method is used in CZT-based SPECT studies.

Single-scan rest/stress imaging with 99mTc-Sestamibi and cadmium zinc telluride-based SPECT for hyperemic flow quantification: A feasibility study evaluated with cardiac magnetic resonance imaging.

INTRODUCTION: We aimed to evaluate whether the hyperemic myocardial blood flow (MBF) can be estimated using cadmium zinc telluride (CZT)-based single-photon emission computed tomography (SPECT) cameras with a single, rapid rest/stress dynamic scan. Dynamic contrast-enhanced (DCE) cardiac magnetic resonance imaging (MRI) was used as a reference modality for flow measurement. MATERIALS AND METHODS: The proposed protocol included both the rest and stress acquisitions within a 24-min scan. Patients were first injected with 99mTc-Sestamibi at the resting state. Sixty minutes after the first injection, the subject was positioned via scintigraphy, after which the list-mode data acquisition was initiated and continued for 24 minutes. Five minutes after data acquisition was initiated, a stressed state was induced via dipyridamole infusion, after which a second dose of 99mTc-Sestamibi was injected. Dynamic SPECT images were reconstructed for all subjects, who also underwent T1-weighted cardiac DCE-MRI performed on days other than those of the SPECT studies. MBF values were estimated for the rest and stress MRI studies, and for the stress portion of the SPECT study. The SPECT-measured hyperemic MBF was compared with the MR-measured hyperemic MBF and coronary flow reserve (CFR), based on the regions of interest. RESULTS: A total of 30 subjects were included in this study. The hyperemic MBF estimated from SPECT showed a strong correlation with the MR-measured hyperemic MBF (r2 = 0.76) and a modest correlation with the MR-measured CFR (r2 = 0.56). Using MR-measured CFR <1.3 as a cutoff for coronary stenosis, we found that the SPECT-measured hyperemic MBF served as a useful clinical index with 94% sensitivity, 90% specificity, and 93% accuracy. CONCLUSIONS: Hyperemic MBF can be measured with a rapid, single-scan rest/stress study with CZT-based SPECT cameras.

Pretreatment Primary Tumor SUVmax on 18F-FDG PET/CT Images Predicts Outcomes in Patients With Salivary Gland Carcinoma Treated With Definitive Intensity-Modulated Radiation Therapy.

PURPOSE: The aim of this study was to investigate the prognostic significance of F-FDG uptake in salivary gland carcinoma (SGC) patients treated with definitive intensity-modulated radiation therapy (IMRT). METHODS: We retrospectively examined 46 SGC patients who received pretreatment F-FDG PET/CT and definitive IMRT between 2007 and 2014. Most tumors were located in the minor salivary glands (n = 35 [76%]). Forty-six percent (n = 21) of the participants had unresectable disease. The median radiation dose was 72 Gy. Treatment outcomes were examined in relation to clinicopathologic parameters and pretreatment primary tumor SUVmax on F-FDG PET/CT. RESULTS: After a median follow-up of 54 months, the 5-year locoregional progression-free survival (LRPFS), distant metastasis-free survival, progression-free survival (PFS), and overall survival (OS) rates were 77%, 75%, 63%, and 61%, respectively. The median primary tumor SUVmax was 7.4 (range, 2.3-23.6), and the optimal cutoff value that maximized the prognostic significance for 5-year PFS was 7.4 (P = 0.006). Patients with a high SUVmax (≥7.4) had significantly lower 5-year LRPFS (P = 0.007), distant metastasis-free survival (P = 0.046), and OS (P = 0.013) rates than those with a low SUVmax (<7.4). Multivariate analyses identified SUVmax as the only independent predictor of LRPFS (P = 0.023) and PFS (P = 0.003), whereas both the performance score (P < 0.001) and SUVmax (P = 0.022) were independently associated with OS. CONCLUSIONS: Pretreatment primary tumor SUVmax on F-FDG PET/CT predicts treatment outcomes in SGC patients. Definitive IMRT is an effective treatment strategy when organ function and cosmesis need to be preserved.

A preliminary investigation into textural features of intratumoral metabolic heterogeneity in (18)F-FDG PET for overall survival prognosis in patients with bulky cervical cancer treated with definitive concurrent chemoradiotherapy.

We examined the role of intratumoral metabolic heterogeneity on (18)F-FDG PET during concurrent chemoradiotherapy (CCRT) in predicting survival outcomes for patients with cervical cancer. This prospective study consisted of 44 patients with bulky (≥ 4 cm) cervical cancer treated with CCRT. All patients underwent serial (18)F-FDG PET studies. Primary cervical tumor standardized uptake values, metabolic tumor volume, and total lesion glycolysis (TLG) were measured in pretreatment and intra-treatment (2 weeks) PET scans. Regional textural features were analyzed using the grey level run length encoding method (GLRLM) and grey-level size zone matrix. Associations between PET parameters and overall survival (OS) were tested by Kaplan-Meier analysis and Cox regression model. In univariate analysis, pretreatment grey-level nonuniformity (GLNU) > 48 by GLRLM textural analysis and intra-treatment decline of run length nonuniformity < 55% and the decline of TLG (∆TLG) < 60% were associated with significantly worse OS. In multivariate analysis, only ∆TLG was significant (P = 0.009). Combining pretreatment with intra-treatment factors, we defined the patients with a initial GLNU > 48 and a ∆TLG ≤ 60% as the high-risk group and the other patients as the low-risk. The 5-year OS rate for the high-risk group was significantly worse than that for the low-risk group (42% vs. 81%, respectively, P = 0.001). The heterogeneity of intratumoral FDG distribution and the early temporal change in TLG may be an important predictor for OS in patients with bulky cervical cancer. This gives the opportunity to adjust individualized regimens early in the treatment course.

TLG-S criteria are superior to both EORTC and PERCIST for predicting outcomes in patients with metastatic lung adenocarcinoma treated with erlotinib.

PURPOSE: In this retrospective review of prospectively collected data, we sought to investigate whether early FDG-PET assessment of treatment response based on total lesion glycolysis measured using a systemic approach (TLG-S) would be superior to either local assessment with EORTC (European Organization for Research and Treatment of Cancer) criteria or single-lesion assessment with PERCIST (PET Response Criteria in Solid Tumors) for predicting clinical outcomes in patients with metastatic lung adenocarcinoma treated with erlotinib. We also examined the effect of bone flares on tumor response evaluation by single-lesion assessment with PERCIST in patients with metastatic bone lesions. METHODS: We performed a retrospective review of prospectively collected data from 23 patients with metastatic lung adenocarcinoma treated with erlotinib. All participants underwent FDG-PET imaging at baseline and on days 14 and 56 after completion of erlotinib treatment. In addition, diagnostic CT scans were performed at baseline and on day 56. FDG-PET response was assessed with TLG-S, EORTC, and PERCIST criteria. Response assessment based on RECIST 1.1 (Response Evaluation Criteria in Solid Tumors) from diagnostic CT imaging was used as the reference standard. Two-year progression-free survival (PFS) and overall survival (OS) served as the main outcome measures. RESULTS: We identified 13 patients with bone metastases. Of these, four (31 %) with persistent bone uptake due to bone flares on day 14 were erroneously classified as non-responders according to the PERCIST criteria, but they were correctly classified as responders according to both the EORTC and TLG-S criteria. Patients who were classified as responders on day 14 based on TLG-S criteria had higher rates of 2-year PFS (26.7 % vs. 0 %, P = 0.007) and OS (40.0 % vs. 7.7 %, P = 0.018). Similar rates were observed in patients who showed a response on day 56 based on CT imaging according to the RECIST criteria. Patients classified as responders on day 14 according to the EORTC criteria on FDG-PET imaging had better rates of 2-year OS than did non-responders (36.4 % vs. 8.3 %, P = 0.015). CONCLUSIONS: TLG-S criteria may be of greater help in predicting survival outcomes than other forms of assessment. Bone flares, which can interfere with the interpretation of treatment response based on PERCIST criteria, are not uncommon in patients with metastatic lung adenocarcinoma treated with erlotinib.

Inter-Strain Differences in Default Mode Network: A Resting State fMRI Study on Spontaneously Hypertensive Rat and Wistar Kyoto Rat.

Genetic divergences among mammalian strains are presented phenotypically in various aspects of physical appearance such as body shape and facial features. Yet how genetic diversity is expressed in brain function still remains unclear. Functional connectivity has been shown to be a valuable approach in characterizing the relationship between brain functions and behaviors. Alterations in the brain default mode network (DMN) have been found in human neuropsychological disorders. In this study we selected the spontaneously hypertensive rat (SHR) and the Wistar Kyoto rat (WKY), two inbred rat strains with close genetic origins, to investigate variations in the DMN. Our results showed that the major DMN differences are the activities in hippocampal area and caudate putamen region. This may be correlated to the hyperactive behavior of the SHR strain. Advanced animal model studies on variations in the DMN may have potential to shed new light on translational medicine, especially with regard to neuropsychological disorders.

Node/aorta and node/liver SUV ratios from (18)F-FDG PET/CT may improve the detection of occult mediastinal lymph node metastases in patients with non-small cell lung carcinoma.

RATIONALE AND OBJECTIVES: Research suggests that the semiquantitative determination of nodal (18)F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)/computed tomography (CT) may be useful for the assessment of mediastinal metastases in patients with non-small-cell lung carcinoma (NSCLC). The aim of this study was to evaluate the diagnostic ability of using different standardized uptake value (SUV) parameters in the detection of ipsilateral mediastinal (N2) disease. MATERIALS AND METHODS: A total of 102 patients newly diagnosed with non-small-cell lung carcinoma who underwent (18)F-FDG PET/CT before surgery and had not received prior therapy were retrospectively included. All patients underwent surgical resection of the primary tumor and mediastinal lymph node dissection. On a station-based analysis, different SUV parameters (eg, mediastinal lymph node SUV, node/aorta SUV ratio, and node/liver SUV ratio) were evaluated using the histopathologic results as the reference standard. The optimal cutoff value for each SUV parameter was determined with receiver-operating characteristic curve analysis. RESULTS: The areas under the receiver-operating characteristic curves were 0.674, 0.693, and 0.715 for node SUV, node/aorta SUV ratio, and node/liver SUV ratio, respectively (P < .05). With cutoff values of 3.15, 1.37, and 1.02 for node SUV, node/aorta SUV ratio, and node/liver SUV ratio, respectively, the sensitivity of (18)F-FDG PET/CT for N2 staging was 57.1%, 85.7%, and 71.4%, and specificity was 74.2%, 50.5%, and 61.9%. CONCLUSIONS: Compared to node SUV alone, the use of node/aorta and node/liver SUV ratios resulted in improved detection of N2 metastases. The two SUV parameters may potentially improve the diagnostic accuracy of (18)F-FDG PET/CT for the diagnosis of N2 disease in patients with non-small-cell lung carcinoma.

Use of positron emission tomography to detect infection around antibiotic-loaded cement spacers in patients with high C-reactive protein levels.

In patients who have antibiotic-loaded cement hip spacers in the interim period, the correct diagnosis of infection eradication is the major determinant before reimplantation arthroplasty. Diagnosis is usually based on clinical findings and serum C-reactive protein (CRP) levels. However, diagnosis can be challenging when the clinical findings are normal but the CRP level is high. From March 2007 to January 2008, fluorodeoxy-glucose positron emission tomography (FDG-PET) was used to detect infection around antibiotic-loaded cement spacers in 13 patients (mean age, 60 years). Although patients' clinical conditions were deemed suitable for reimplantation, their serum CRP levels were persistently elevated (mean, 54 mg/L) an average of 120 days (range, 28-413 days) after the first-stage operation. Reimplantation total hip arthroplasty (THA) was subsequently performed in 7 patients based on the negative findings of FDG-PET. In 6 patients, FDG-PET was positive for infection. The persistence of infection was confirmed in 3 of these patients by another debridement surgery. Staged reimplantation THA was delayed in 1 patient who underwent repeat debridement and in 3 patients who were treated with extended periods of oral antibiotics. Of the 11 staged reimplantation THAs, only 1 reinfection was noted at an average follow-up of 48 months. The success rate of 91% suggests FDG-PET could help in the differential diagnosis of infection around cement spacers, especially in patients with normal clinical findings but elevated CRP levels.

Identification of prognostic factors in patients with cervical cancer and supraclavicular lymph node recurrence.

OBJECTIVE: Patients with cervical cancer and supraclavicular lymph nodes (SLN) recurrence have a poor but heterogeneous prognosis. The aim of this study was to identify potential prognostic factors - including FDG-PET results - that may affect survival and treatment outcomes in patients with this group of patients. METHODS: Between January 2001 and December 2008, we identified a total of 31 consecutive patients with cervical cancer who had evidence of SLN recurrence. All participants underwent FDG-PET. Survival was measured from the date of documented SLN recurrence. The latency period was defined as the length of time from the date of first diagnosis to the date of SLN recurrence. RESULTS: The median follow-up time was 22.8 months (range: 4.7-105.1). The 3- and 5-year survival rates were 41% and 27.3%, respectively. Patients with intermediate SUV values (between 4.3 and 8) had a significantly better prognosis than subjects with both high (>8) or low (<4.3) SUV values (p=0.004). Latency period <2 years, SCC-Ag levels ≥ 4ng/mL, recurrence extend beyond SLN, and SUV of <4.3 >8 were significant adverse prognostic factors by multivariate analysis. The 3-year overall survival (OS) rate of patients carrying 0-1 adverse prognostic factors was 90% (low-risk group), while 3-year OS rates for intermediate-risk group (2 factors) and high-risk group (3-4 factors) were 30% and 0%, respectively (p=0.001). CONCLUSION: Our results justify the use of PET (accurate extent of relapse and SUV) as a prognostic tool in patients with cervical cancer and SLN recurrence.

Feasibility of sentinel lymph node biopsy in multifocal/multicentric breast cancer.

BACKGROUND: Sentinel lymph node (SLN) biopsy can replace axillary lymph node dissection (ALND) in prediction of nodal status in node-negative breast cancer. However, patients presenting with multifocal/multicentric (MF/MC) breast cancer are usually excluded from studies of SLN biopsy. This study evaluated the efficacy of SLN biopsy in patients with MF/MC breast cancer. METHODS: Breast cancer patients who underwent preoperative lymphoscintigraphy and SLN biopsy with backup ALND from 2004 to 2006 were retrospectively reviewed. Patients enrolled in this study had clinically node-negative unifocal or MF/MC breast cancer based on final histology. Sentinel node biopsy was performed with a 2-day protocol with intradermal radiocolloid injection on day one and SLN biopsy on day two. Histopathologic parameters and the efficacy of the SLN biopsy were compared between unifocal and MF/MC breast cancers. RESULTS: This study enrolled 158 breast cancer patients; one hundred and thirty-five patients were diagnosed with unifocal and 23 with MF/MC breast cancer. The mean numbers of SLNs retrieved were 1.3 for the unifocal and 1.1 for the MF/MC groups. The identification rate, sensitivity, accuracy, and false-negative rate for unifocal and MF/MC breast cancers were 94.8%, 92.6%, 98.4%, and 7.4%; and 100%, 100%, 100%, and 0%, respectively. No significant differences were observed between the two groups for SLN identification, sensitivity, accuracy, and false-negative rate. CONCLUSION: Sentinel lymph node biopsy using intradermal radiocolloid injection method is feasible for MF/MC breast cancer.

Myometrial invasion in endometrial cancer: diagnostic accuracy of diffusion-weighted 3.0-T MR imaging--initial experience.

PURPOSE: To assess the diagnostic accuracy of fused T2-weighted and high-b-value diffusion-weighted (DW) magnetic resonance (MR) images at 3 T for evaluation of myometrial invasion in patients with endometrial cancer. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. From May 2006 to October 2007, 48 consecutive patients aged 25-80 years (mean age, 57 years) who had endometrial cancer were prospectively enrolled for preoperative evaluation by using a 3-T MR unit. Two radiologists interpreted the depth of myometrial invasion on T2-weighted images, dynamic contrast material-enhanced MR images, and fused T2-weighted and DW MR images (b = 1000 sec/mm(2)). Statistical methods included kappa statistics for reader agreement, Pearson analysis for pathologic correlation, accuracy assessment, and receiver operating characteristic analysis for diagnostic performance comparison. Surgical pathologic findings were the reference standard. RESULTS: Reader agreement was excellent for fused T2-weighted and DW images (weighted kappa, 0.79), with a significant pathologic correlation regarding the depth of myometrial invasion (r = 0.94, P < .0001). For assessing any myometrial involvement, addition of fused T2-weighted and DW imaging to dynamic contrast-enhanced or dynamic contrast-enhanced and T2-weighted imaging was significantly better compared with dynamic contrast-enhanced imaging alone (P < .001) or dynamic contrast-enhanced and T2-weighted (P = .001) imaging; T2-weighted imaging combined with fused T2-weighted and DW imaging also was better than dynamic contrast-enhanced and T2-weighted imaging (P = .001). Tumor apparent diffusion coefficients were 0.60-1.32 x 10(-3) mm(2)/sec (median, 0.75 x 10(-3) mm(2)/sec), with no significant correlation with the depth of myometrial invasion (P = .31, r = -0.15). CONCLUSION: Fused T2-weighted and high-b-value DW images at 3 T can provide accurate information for preoperative evaluation of myometrial invasion.

Correlation of apparent diffusion coefficients measured by 3T diffusion-weighted MRI and SUV from FDG PET/CT in primary cervical cancer.

PURPOSE: Diffusion-weighted magnetic resonance imaging (DWI) and fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) are oncological feasible techniques. Currently, apparent diffusion coefficient (ADC) measured by DWI and standard uptake value (SUV) from FDG PET/CT have similar applications in clinical oncology. The aim of this study was to assess the correlation between ADC and SUV in primary cervical cancer. MATERIALS AND METHODS: Patients with documented primary cervical cancer were recruited. All participants underwent abdominopelvic DWI at 3T and FDG PET/CT within 2 weeks. For the primary tumor, ADC was measured as minimum ADC (ADC(min)) and mean ADC (ADC(mean)) within the whole tumor by DWI. Maximum SUV (SUV(max)) and mean SUV (SUV(mean)) were measured by FDG PET/CT. RESULTS: A total of 33 patients were included. There was no significant correlation either between ADC(min) and SUV(max) or between ADC(mean) and SUV(mean). The relative ADC(min) (rADC(min)) defined as ADC(min)/ADC(mean) ratio was significantly inversely correlated with the relative SUV(max) (rSUV(max)) defined as SUV(max)/SUV(mean) ratio (r = -0.526, P = 0.0017) in all study patients. A significantly inverse correlation between rADC(min) and rSUV(max) was observed in patients with adenocarcinoma/adenosquamous carcinoma (r = -0.685, P = 0.0012) and those with well-to-moderate differentiated tumor (r = -0.631, P = 0.0050). No significant correlation was demonstrated in patients with squamous cell carcinoma or poorly differentiated tumor. CONCLUSIONS: The significantly inverse correlation between rADC(min) and rSUV(max) in primary cervical tumor suggests that DWI and FDG PET/CT might play a complementary role for the clinical assessment of this cancer type.