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Bower N, Morris A, O'Connor J, Sponagle M, Bahr R, Gilbert R, Mohamed A, Bower J. Clinical value of whole body 18F-FDG PET/CT imaging in patients with cutaneous melanoma: A multi-center cohort study. J Med Imaging Radiat Sci 2024; 55:212-220. [PMID: 38403520 DOI: 10.1016/j.jmir.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/19/2023] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND 18F-FDG-PET/CT is a valuable tool in the staging and surveillance of cutaneous melanoma; however, recent studies prompt debate on the clinical significance of imaging patients below the lesser trochanter. This study explored two research questions. In patients with a known primary cutaneous melanoma within the standard field of view (SFOV, between the orbits and lesser trochanter), what is the prevalence of metastasis to sites solely within the lower extremities? and, In patients with a known primary cutaneous melanoma within the SFOV what demographic and clinical factors are associated with sole metastasis to the lower extremities? METHODS A retrospective, multi-centered, observational study of consecutive case reports was conducted. Subjects included 619 patients who underwent extended field of view (EFOV) 18F-FDG-PET/CT (from vertex to toes) for staging and/or follow-up of cutaneous melanoma. Data was collected at three primary healthcare centers in Canada (Nova Scotia, Alberta, and British Columbia). Inclusion criteria were patients >18 years of age, confirmed primary cutaneous melanoma, and a known location of the primary within the SFOV. Patients with primary cutaneous melanoma lesions in lower extremities and previous other cancers were excluded. To determine the prevalence of lesions located below the lesser trochanter, the proportion of such lesions were computed, and 95% confidence intervals ensured a precise estimation of the proportion. RESULTS 2512 patient charts were reviewed with 619 meeting the inclusion criteria, 298 of these were females. Six percent had metastases in both the lower extremities and sites within the SFOV. The number of subjects who had no metastasis within their SFOV was 361 (58.3%). The number of subjects who presented with confirmed metastasis in the lower extremities without concurrent metastasis in the SFOV region was one (0.58%). Despite a large initial study sample, the number of patients with metastasis in the lower extremities was insufficient to allow correlation of factors associated with risk of spread to the lower extremities. CONCLUSION Lower extremity 18F-FDG-PET/CT provided additional, relevant clinical data in a sole patient. This finding supports prior research suggesting the prevalence is rare. Future studies should seek to define demographic and clinical factors that predict such rare occurrences, where follow up would be warranted. This study highlights feasibility challenges associated with such investigation.
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Affiliation(s)
- Nichole Bower
- School of Health Sciences Dalhousie University, Nova Scotia Health.
| | - Amy Morris
- School of Health & Public Safety, Nuclear Medicine Technology Program, Southern Alberta Institute of Technology; Nuclear Medicine & PET/CT, Foothills Medical Centre, Alberta Health Services
| | - Janet O'Connor
- Department of Diagnostic Imaging, Nuclear Medicine and PET/CT, Thunder Bay Regional Health Sciences Centre
| | - Melissa Sponagle
- School of Health Sciences Dalhousie University, Nova Scotia Health
| | - Rebekah Bahr
- Functional Imaging, PET/CT, BC Cancer- Vancouver Center
| | - Robert Gilbert
- School of Health Sciences Dalhousie University, Nova Scotia Health
| | - Abdolell Mohamed
- Department of Diagnostic Radiology, Faculty of Medicine, Dalhousie University, Affiliated Scientist, QEII Health Sciences Centre
| | - Jonathan Bower
- Department of Diagnostic Imaging Information Systems, Nova Scotia Health
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Brodhead M, Woods RW, Fowler AM, Roy M, Neuman H, Gegios A. Multimodality imaging review of metastatic melanoma involving the breast. Curr Probl Diagn Radiol 2024; 53:289-296. [PMID: 38307731 DOI: 10.1067/j.cpradiol.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/04/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024]
Abstract
Melanoma is among the most commonly reported non-mammary primary tumors to metastasize to the breast. Unfortunately, evidence of melanoma metastasis to any site portends a poor prognosis. Imaging studies can be useful in the early detection of metastatic melanoma which is essential for appropriate management of this disease. There have been very few previous studies on the imaging findings of metastatic melanoma especially across multiple imaging modalities. This review aims to describe these imaging features seen on mammography, ultrasound, magnetic resonance imaging (MRI) and fluorodeoxyglucose-positron emission tomography computed tomography (FDG PET/CT) using three case examples. Our findings, consistent with previous studies, describe melanoma metastases to the breast as largely non-specific, round or oval masses with circumscribed margins and homogeneous internal enhancement.
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Affiliation(s)
| | - Ryan W Woods
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, United States.
| | - Amy M Fowler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, United States; University of Wisconsin Carbone Cancer Center, 600 Highland Avenue, Madison, WI 53792, United States; Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 1111 Highland Avenue, Madison, WI 53705, United States
| | - Madhuchhanda Roy
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, United States
| | - Heather Neuman
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, United States
| | - Alison Gegios
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, United States
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3
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Sinclair R, Wong XL, Shumack S, Baker C, MacMahon B. The role of micrometastasis in high-risk skin cancers. Australas J Dermatol 2024; 65:143-152. [PMID: 38156714 DOI: 10.1111/ajd.14206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/30/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024]
Abstract
The propensity to metastasize is the most important prognostic indicator for solid cancers. New insights into the mechanisms of early carcinogenesis have revealed micrometastases are generated far earlier than previously thought. Evidence supports a synergistic relationship between vascular and lymphatic seeding which can occur before there is clinical evidence of a primary tumour. Early vascular seeding prepares distal sites for colonisation while regional lymphatics are co-opted to promote facilitative cancer cell mutations. In response, the host mounts a global inflammatory and immunomodulatory response towards these cells supporting the concept that cancer is a systemic disease. Cancer staging systems should be refined to better reflect cancer cell loads in various tissue compartments while clinical perspectives should be broadened to encompass this view when approaching high-risk cancers. Measured adjunctive therapies implemented earlier for low-volume, in-transit cancer offers the prospect of preventing advanced disease and the need for heroic therapeutic interventions. This review seeks to re-appraise how we view the metastatic process for solid cancers. It will explore in-transit metastasis in the context of high-risk skin cancer and how it dictates disease progression. It will also discuss how these implications will influence our current staging systems and its consequences on management.
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Affiliation(s)
- Robert Sinclair
- Queensland Institute of Dermatology, Brisbane, QLD, Australia
| | - Xin Lin Wong
- St George Dermatology and Skin Cancer Centre, New South Wales, Kogarah, Australia
| | - Stephen Shumack
- St George Dermatology and Skin Cancer Centre, New South Wales, Kogarah, Australia
- Department of Dermatology, Royal North Shore Hospital, New South Wales, Sydney, Australia
| | - Christopher Baker
- Department of Dermatology, St Vincents Hospital, Victoria, Melbourne, Australia
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Zamani-Siahkali N, Mirshahvalad SA, Pirich C, Beheshti M. Diagnostic Performance of [ 18F]F-FDG Positron Emission Tomography (PET) in Non-Ophthalmic Malignant Melanoma: A Systematic Review and Meta-Analysis of More Than 10,000 Melanoma Patients. Cancers (Basel) 2024; 16:215. [PMID: 38201642 PMCID: PMC10778455 DOI: 10.3390/cancers16010215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
We described the diagnostic performance of [18F]F-FDG-PET in malignant melanoma by conducting a comprehensive systematic review and meta-analysis of the existing literature. The study was designed following PRISMA-DTA. Original articles with adequate crude data for meta-analytic calculations that evaluated [18F]F-FDG-PET and compared it with a valid reference standard were considered eligible. The pooled measurements were calculated based on the data level (patient/lesion-based). Regarding sub-groups, diagnostic performances were calculated for local, regional and distant involvement. The bivariate model was employed to calculate sensitivity and specificity. The initial search resulted in 6678 studies. Finally, 100 entered the meta-analysis, containing 82 patient-based (10,403 patients) and 32 lesion-based (6188 lesions) datasets. At patient level, overall, [18F]F-FDG-PET had pooled sensitivity and specificity of 81% (95%CI: 73-87%) and 92% (95%CI: 90-94%), respectively. To detect regional lymph node metastasis, the pooled sensitivity and specificity were 56% (95%CI: 40-72%) and 97% (95%CI: 94-99%), respectively. To detect distant metastasis, they were 88% (95%CI: 81-93%) and 94% (95%CI: 91-96%), respectively. At lesion level, [18F]F-FDG-PET had a pooled sensitivity and specificity of 70% (95%CI: 57-80%) and 94% (95%CI: 88-97%), respectively. Thus, [18F]F-FDG-PET is a valuable diagnostic modality for melanoma assessment. It was accurate in various clinical scenarios. However, despite its high specificity, it showed low sensitivity in detecting regional lymph node metastasis and could not replace lymph node biopsy.
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Affiliation(s)
- Nazanin Zamani-Siahkali
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
- Department of Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran 1461884513, Iran
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
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Wu CE, Liao YH, Wu CL, Yen RF, Lin CC, Yang MH, Yen CC, Su WC, Yen CJ, Chang YF, Wu MF, Yang Y, Lin CY, Yang WC, Wang HC, Li CY, Ho YY, Chang YY, Wu CS, Hsu HC, Chen KH, Huang Y, Chen CJ, Chuang PJ, Lai YC, Huang YY, Tseng NC, Huang YT, Chu CY, Wen-Cheng Chang J. Clinical practice consensus for the diagnosis and management of melanoma in Taiwan. J Formos Med Assoc 2024; 123:7-15. [PMID: 37690868 DOI: 10.1016/j.jfma.2023.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 05/09/2023] [Accepted: 07/21/2023] [Indexed: 09/12/2023] Open
Abstract
Melanoma is rare in Taiwan. Asian melanoma is distinct from Western melanoma because acral and mucosal melanoma accounts for the majority of melanoma cases, leading to distinct tumor behaviors and genetic profiling. With consideration of the clinical guidelines in Western countries, Taiwanese experts developed a local clinical practice consensus guideline. This consensus includes diagnosis, staging, and surgical and systemic treatment, based only on clinical evidence, local epidemiology, and available resources evaluated by experts in Taiwan. This consensus emphasizes the importance of surgical management, particularly for sentinel lymph node biopsies. In addition, molecular testing for BRAF is mandatory for patients before systemic treatment. Furthermore, immunotherapy and targeted therapy are prioritized for systemic treatment. This consensus aimed to assist clinicians in Taiwan in diagnosing and treating patients according to available evidence.
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Affiliation(s)
- Chiao-En Wu
- Division of Hematology/Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Yi-Hua Liao
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Lin Wu
- Department of Pathology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ruoh-Fang Yen
- Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chia-Chi Lin
- Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Muh-Hwa Yang
- Division of Medical Oncology, Center for Immuno-oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chueh-Chuan Yen
- Division of Medical Oncology, Center for Immuno-oncology, Department of Oncology, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Clinical Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Biopharmaceutical Sciences, College of Pharmaceutical Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wu-Chou Su
- Department of oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan city, Taiwan
| | - Chia-Jui Yen
- Department of oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan city, Taiwan
| | - Yi-Fang Chang
- Division of Hematology & Oncology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ming-Fang Wu
- Department of Medical Oncology, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Youngsen Yang
- Division of Hematology-Oncology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chen-Yuan Lin
- Department of Hematology and Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Chi Yang
- Division of Hematology & Oncology, Pingtung Christian Hospital, Pingtung, Taiwan
| | - Hui-Ching Wang
- Division of Hematology & Oncology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan
| | - Cheng-Yuan Li
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yin-Yu Ho
- Department of Dermatology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yao-Yu Chang
- Department of Dermatology, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chieh-Shan Wu
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hsiu-Cheng Hsu
- Department of Dermatology, Changhua Christian Hospital, Changhua County, Taiwan
| | - Kuang-Hua Chen
- Department of Anatomic Pathology, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Yenlin Huang
- Department of Anatomic Pathology, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan; School of Medicine, National Tsing-Hua University, Hsinchu, Taiwan; Institute of Stem Cell and Translational Cancer Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Jung Chen
- Department of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Pei-Ju Chuang
- Department of Nuclear Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan
| | - Yung-Chi Lai
- Department of Nuclear Medicine, Feng Yuan Hospital, Ministry of Health and Welfare, Taichung 420210, Taiwan
| | - Yu-Yi Huang
- Department of Nuclear Medicine, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Neng-Chuan Tseng
- Division of Nuclear Medicine, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan
| | - Yi-Ting Huang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chang Gung University Medical College, Linkou Branch, Taoyuan, Taiwan
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - John Wen-Cheng Chang
- Division of Hematology/Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan.
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Kalantari F, Mirshahvalad SA, Hoellwerth M, Schweighofer-Zwink G, Huber-Schönauer U, Hitzl W, Rendl G, Koelblinger P, Pirich C, Beheshti M. Prognostic Value of Baseline 18F-FDG PET/CT to Predict Brain Metastasis Development in Melanoma Patients. Cancers (Basel) 2023; 16:127. [PMID: 38201554 PMCID: PMC10778001 DOI: 10.3390/cancers16010127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
To investigate the value of 18F-FDG-PET/CT in predicting the occurrence of brain metastases in melanoma patients, in this retrospective study 201 consecutive patients with pathology-proven melanoma, between 2008 and 2021, were reviewed. Those who underwent 18F-FDG-PET/CT for initial staging were considered eligible. Baseline assessment included histopathology, 18F-FDG-PET/CT, and brain MRI. Also, all patients had serial follow-ups for diagnosing brain metastasis development. Baseline 18F-FDG-PET/CT parameters were analysed using competing risk regression models to analyze their correlation with the occurrence of brain metastases. Overall, 159 patients entered the study. The median follow-up was six years. Among clinical variables, the initial M-stage and TNM-stage were significantly correlated with brain metastasis. Regarding 18F-FDG-PET/CT parameters, regional metastatic lymph node uptake values, as well as prominent SULmax (pSULmax) and prominent SUVmean (pSUVmean), were significantly correlated with the outcome. Cumulative incidences were 10% (6.3-16%), 31% (24.4-38.9%), and 35.2% (28.5-43.5%) after 1, 5, and 10 years. There were significant correlations between pSULmax (p-value < 0.001) and pSULpeak (p-value < 0.001) and the occurrence of brain metastases. The higher these values, the sooner the patient developed brain metastases. Thus, baseline 18F-FDG-PET/CT may have the potential to predict brain metastasis in melanoma patients. Those with high total metabolic activity should undergo follow-up/complementary evaluations, such as brain MRI.
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Affiliation(s)
- Forough Kalantari
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (F.K.); (S.A.M.); (G.S.-Z.); (U.H.-S.); (G.R.); (C.P.)
- Department of Nuclear Medicine, University Hospital, Iran University of Medical Sciences, 1461884513 Tehran, Iran
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (F.K.); (S.A.M.); (G.S.-Z.); (U.H.-S.); (G.R.); (C.P.)
- Joint Department of Medical Imaging (University Medical Imaging Toronto (UMIT)), University Health Network, Mount Sinai Hospital–Women’s College Hospital, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Magdalena Hoellwerth
- Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.H.); (P.K.)
| | - Gregor Schweighofer-Zwink
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (F.K.); (S.A.M.); (G.S.-Z.); (U.H.-S.); (G.R.); (C.P.)
| | - Ursula Huber-Schönauer
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (F.K.); (S.A.M.); (G.S.-Z.); (U.H.-S.); (G.R.); (C.P.)
| | - Wolfgang Hitzl
- Biostatistics and Publication of Clinical Trial Studies, Research and Innovation Management (RIM), Paracelsus Medical University, 5020 Salzburg, Austria;
- Department of Ophthalmology and Optometry, Paracelsus Medical University, 5020 Salzburg, Austria
- Research Program Experimental Ophthalmology & Glaucoma Research, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Gundula Rendl
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (F.K.); (S.A.M.); (G.S.-Z.); (U.H.-S.); (G.R.); (C.P.)
| | - Peter Koelblinger
- Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (M.H.); (P.K.)
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (F.K.); (S.A.M.); (G.S.-Z.); (U.H.-S.); (G.R.); (C.P.)
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, 5020 Salzburg, Austria; (F.K.); (S.A.M.); (G.S.-Z.); (U.H.-S.); (G.R.); (C.P.)
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Johnston L, Starkey S, Mukovozov I, Robertson L, Petrella T, Alhusayen R. Surveillance After a Previous Cutaneous Melanoma Diagnosis: A Scoping Review of Melanoma Follow-Up Guidelines. J Cutan Med Surg 2023; 27:516-525. [PMID: 37489919 PMCID: PMC10617001 DOI: 10.1177/12034754231188434] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/30/2023] [Accepted: 06/20/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION Cutaneous melanoma accounts for more than 70% of all skin cancer deaths. Follow-up surveillance is an integral part of melanoma patient care, to facilitate early detection of recurrences and subsequent primary melanomas. The purpose of this scoping review is to provide an overview of recently published melanoma surveillance guidelines from regional and national melanoma working groups. METHODS A systematic search for relevant studies in MEDLINE and Embase was conducted in September 2022 and was limited to publications from 2010 or later. RESULTS A total of 1047 articles were retrieved, and after abstract and full text review, 26 articles from 19 different organizations met inclusion criteria. Life-long annual skin surveillance with a physician was recommended by 53% (9/17) of guidelines. Routine laboratory investigations were recommended by 7/19 guidelines. Regional lymph node ultrasound was recommended by 9/16 guidelines, most often in stage IB or higher, and was optional in 7/16 for patients who met specific criteria. Surveillance with PET-CT or CT and MRI was recommended by 15 and 11 guidelines, respectively, most commonly in stage IIC or higher, with a variable frequency and total duration. Five out of 9 guidelines indicated a preference for skin surveillance to be completed with a dermatologist. CONCLUSION Guidelines were highly variable for many aspects of melanoma surveillance, which may be partly attributed to regional differences in healthcare workforce distribution and availability of imaging technologies. Further high-level studies are recommended to provide more evidence on the most effective clinical and imaging follow-up surveillance protocols.
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Affiliation(s)
- Leah Johnston
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Samantha Starkey
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Ilya Mukovozov
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Lynne Robertson
- Division of Dermatology, University of Calgary, Calgary, AB, Canada
| | - Teresa Petrella
- Department of Medical Oncology, Odette Cancer Centre, Toronto, Canada
| | - Raed Alhusayen
- Sunnybrook Research Institute, Division of Dermatology, University of Toronto, Toronto, Canada
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Ayati N, Jamshidi-Araghi Z, Hoellwerth M, Schweighofer-Zwink G, Hitzl W, Koelblinger P, Pirich C, Beheshti M. Predictive value and accuracy of [ 18F]FDG PET/CT modified response criteria for checkpoint immunotherapy in patients with advanced melanoma. Eur J Nucl Med Mol Imaging 2023; 50:2715-2726. [PMID: 37140669 PMCID: PMC10317870 DOI: 10.1007/s00259-023-06247-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Abstract
PURPOSE Immune checkpoint inhibitors (ICIs) are widely used in metastatic melanoma and dramatically alter the treatment of these patients. Given the high cost and potential toxicity, a reliable method for evaluating treatment response is needed. In this study, we assessed tumor response in patients with metastatic melanoma treated with ICIs using three modified response criteria: PET Response Evaluation Criteria for Immunotherapy (PERCIMT), PET Response Criteria in Solid Tumors for up to Five Lesions (PERCIST5), and immunotherapy-modified PET Response Criteria in Solid Tumors for up to Five Lesions (imPERCIST5). METHODS Ninety-one patients with non-resectable stage IV metastatic melanoma who received ICIs were retrospectively enrolled in this study. Each patient had two [18F]FDG PET/CT scans performed before and after ICI therapy. Responses at the follow-up scan were evaluated according to PERCIMT, PERCIST5, and imPERCIST5 criteria. Patients were classified into four groups: complete metabolic response (CMR), partial metabolic response (PMR), progressive metabolic disease (PMD), and stable metabolic disease (SMD). To assess the "disease control rate," two groups have been defined based on each criterion: patients with CMR, PMR, and SMD as "disease-controlled group (i.e., responders)" and PMD as the "uncontrolled-disease group (i.e., non-responders)". The correspondence between metabolic tumor response defined by these criteria and clinical outcome was assessed and compared. RESULTS The response and the disease control rates were 40.7% and 71.4%, 41.8% and 50.5%, and 54.9% and 74.7% based on the PERCIMT, PERCIST5, and imPERCIST5 criteria, respectively. PERCIMT and imPERCIST5 showed significantly different disease control rates from that of PERCIST5 (P < 0.001), whereas it was not significant between PERCIMT and imPERCIST5. Overall survival was significantly longer in the metabolic responder groups than in the non-responder groups based on PERCIMT and PERCIST5 criteria (PERCIMT: 2.48 versus 1.47 years, P = 0.003; PERCIST5: 2.57 versus 1.81 years. P = 0.017). However, according to imPERCIST5 criterion, this difference was not observed (P = 0.12). CONCLUSION Although the appearance of new lesions can be secondary to an inflammatory response to ICIs and indicative of pseudoprogression, given the higher rate of true progression, the appearance of new lesions should be interpreted deliberately. Of the three assessed modified criteria, PERCIMT appear to provide more reliable metabolic response assessment that correlates strongly with overall patient survival.
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Affiliation(s)
- Narjess Ayati
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Zahra Jamshidi-Araghi
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
- Department of Nuclear Medicine, Shahid Rajaie Cardiovascular, Medical & Research Center, Tehran, Iran
| | - Magdalena Hoellwerth
- Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Gregor Schweighofer-Zwink
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Wolfgang Hitzl
- Biostatistics and Publication of Clinical Trial Studies, Research and Innovation Management (RIM), Paracelsus Medical University, Salzburg, Austria
- Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburg, Austria
- Research Program Experimental Ophthalmology & Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Peter Koelblinger
- Department of Dermatology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria.
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9
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Rashid RJ, Tahir SH, Kakamad FH, Omar SS, Salih AM, Ahmed SF, Abdalla SH, Naqar S, Salih RQ, Kakamad SH, Mohammed KK, Mustafa SM, Hassan MN, Mohammed SH. Whole‑body MRI for metastatic workup in patients diagnosed with cancer. Mol Clin Oncol 2023; 18:33. [PMID: 36925744 PMCID: PMC10011947 DOI: 10.3892/mco.2023.2629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 01/17/2023] [Indexed: 03/05/2023] Open
Abstract
Early diagnosis and appropriate staging workup are crucial for cancer patients. Whole-body magnetic resonance imaging (WB-MRI) has been proposed as another practical whole-body approach for assessing local invasiveness and distant metastases in patients newly diagnosed with cancer. The current study aimed to evaluate the efficacy of WB-MRI in assessing metastasis in patients newly diagnosed with cancer using histopathologic data as the reference method. A prospective observational study was performed from April 2018 to July 2020. MRI sequences were utilized to acquire anatomical and functional images in three orthogonal planes. The discovery was classified as nodal, skeletal and visceral metastases. Patient-based analysis was used for visceral metastasis and region-based for skeletal, systemic and lymph node metastases. A total of 43 consecutive patients (mean age, 56±15.2 years) were assessed successively. In 41 patients, there was a concordance between the WB-MRI and histological confirmation. The most prevalent site of metastasis was the skeletal system (18 patients). There were 12 individuals with liver metastasis, 10 with lung metastasis and 4 with peritoneal metastasis, with just one brain metastatic lesion found. On WB-MRI, 38 lymph node groups were deemed positive. Out of the total, 66 skeletal locations contained metastases. The accuracy of WB-MRI for nodal, skeletal and visceral metastases was (98.45, 100 and 100%, respectively). In conclusion, WB-MRI in three orthogonal planes, including the diffusion-weighted MRI with background body signal suppression sequence, may be utilized efficiently and accurately for assessing metastasis staging and may thus be utilized in patients with newly diagnosed cancer.
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Affiliation(s)
- Rezheen J Rashid
- Department of Oncology, Hiwa Cancer Hospital Centre, Sulaimani Directorate of Health, Sulaimani, Kurdistan 46000, Iraq.,Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
| | - Soran H Tahir
- Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq.,Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq
| | - Fahmi H Kakamad
- Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq.,Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq.,Kscien Organization, Sulaimani, Kurdistan 46000, Iraq
| | - Sami S Omar
- Kscien Organization, Sulaimani, Kurdistan 46000, Iraq.,Rizgary Oncology Center, Erbil, Kurdistan 44000, Iraq
| | - Abdulwahid M Salih
- Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq.,Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq
| | - Shaho F Ahmed
- Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq
| | - Shalaw H Abdalla
- Department of Oncology, Hiwa Cancer Hospital Centre, Sulaimani Directorate of Health, Sulaimani, Kurdistan 46000, Iraq
| | - Sharo Naqar
- Department of Oncology, Hiwa Cancer Hospital Centre, Sulaimani Directorate of Health, Sulaimani, Kurdistan 46000, Iraq.,Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq
| | - Rawezh Q Salih
- Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq.,Kscien Organization, Sulaimani, Kurdistan 46000, Iraq
| | | | | | - Shevan M Mustafa
- Kscien Organization, Sulaimani, Kurdistan 46000, Iraq.,Rizgary Oncology Center, Erbil, Kurdistan 44000, Iraq.,Medical Laboratory Technician Department, Al Qalam University College, Kirkuk, Kurdistan 46000, Iraq
| | - Marwan N Hassan
- Smart Health Tower, Sulaimani, Kurdistan 46000, Iraq.,Department of Surgery, College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46000, Iraq.,Kscien Organization, Sulaimani, Kurdistan 46000, Iraq
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10
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Radiochemistry with {Al18F}2+: Current status and optimization perspectives for efficient radiofluorination by complexation. Coord Chem Rev 2023. [DOI: 10.1016/j.ccr.2023.215028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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11
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Filippi L, Bianconi F, Schillaci O, Spanu A, Palumbo B. The Role and Potential of 18F-FDG PET/CT in Malignant Melanoma: Prognostication, Monitoring Response to Targeted and Immunotherapy, and Radiomics. Diagnostics (Basel) 2022; 12:diagnostics12040929. [PMID: 35453977 PMCID: PMC9028862 DOI: 10.3390/diagnostics12040929] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 12/17/2022] Open
Abstract
Novel therapeutic approaches, consisting of immune check-point inhibitors (ICIs) and molecularly targeted therapy, have thoroughly changed the clinical management of malignant melanoma (MM), the most frequent and deadly skin cancer. Since only 30–40% of MM patients respond to ICIs, imaging biomarkers suitable for the pre-therapeutic stratification and response assessment are warmly welcome. In this scenario, positron emission computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) has been successfully utilized for advanced MM staging and therapy response evaluation. Furthermore, several PET-derived parameters (SUVmax, MTV, TLG) were particularly impactful for the prognostic evaluation of patients submitted to targeted and immunotherapy. In this review, we performed a web-based and desktop research on the clinical applications of 18F-FDG PET/CT in MM, with a particular emphasis on the various metabolic criteria developed for interpreting PET/CT scan in patients undergoing immunotherapy or targeted therapy or a combination of both. Furthermore, the emerging role of radiomics, a quantitative approach to medical imaging applying analysis methodology derived by the field of artificial intelligence, was examined in the peculiar context, putting a particular emphasis on the potential of this discipline to support clinicians in the delicate process of building patient-tailored pathways of care.
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Affiliation(s)
- Luca Filippi
- Nuclear Medicine Unit, “Santa Maria Goretti” Hospital, Via Antonio Canova, 04100 Latina, Italy
- Correspondence: ; Tel.: +39-077-3655-3591
| | - Francesco Bianconi
- Department of Engineering, Università Degli Studi di Perugia, Via Goffredo Duranti 93, 06135 Perugia, Italy;
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University Tor Vergata, Viale Oxford 81, 00133 Rome, Italy;
- IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Angela Spanu
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 8, 07100 Sassari, Italy;
| | - Barbara Palumbo
- Section of Nuclear Medicine and Health Physics, Department of Medicine and Surgery, Università Degli Studi di Perugia, Piazza Lucio Severi 1, 06132 Perugia, Italy;
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12
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Amrane K, Le Meur C, Thuillier P, Alemany P, Niel C, Renault D, Abgral R. Case report: Eosinophilic fasciitis induced by pembrolizumab with high FDG uptake on 18F-FDG-PET/CT. Front Med (Lausanne) 2022; 9:1078560. [PMID: 36606046 PMCID: PMC9807755 DOI: 10.3389/fmed.2022.1078560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Eosinophilic fasciitis (EF) is a rare connective tissue disorder causing inflammation and fibrosing of fascia. In this study, we present a very rare case of an immune checkpoint inhibitor (ICI)-induced EF revealed by 18F-fluorodesoxyglucose positron emission tomography (FDG-PET/CT) 20 months after the initiation of Pembrolizumab treatment of a relapsed non-small cell lung cancer (NSCLC). This study presents a 52-year-old Caucasian woman clinically presenting asthenia, inflammatory muscle, and joint pain associated with subcutaneous nodules and symmetrical edema of the lower limbs. Iterative 18FDG-PET/CT scans allow us to guide the therapeutic strategy due to this atypical ICI adverse event.
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Affiliation(s)
- Karim Amrane
- Department of Oncology, Centre Hospitalier des Pays de Morlaix, Morlaix, France.,Institut National de la Santé et de la Recherche Médicale UMR 1227, Lymphocytes B et Autoimmunité, Univ. Brest, Institut National de la Santé et de la Recherche Médicale, LabEx IGO, Brest, France
| | - Coline Le Meur
- Department of Oncology, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - Philippe Thuillier
- Institut National de la Santé et de la Recherche Médicale UMR 1304 GETBO, University of Western Brittany, Brest, France.,Department of Endocrinology, University Hospital of Brest, Brest, France
| | - Pierre Alemany
- Department of Pathology, Ouest Pathologie, Brest, France
| | - Clémence Niel
- Department of Pneumology, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - David Renault
- Department of Pneumology, Centre Hospitalier des Pays de Morlaix, Morlaix, France
| | - Ronan Abgral
- Department of Endocrinology, University Hospital of Brest, Brest, France.,Department of Nuclear Medicine, University Hospital of Brest, Brest, France
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13
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Alipour R, Iravani A, Hicks RJ. PET Imaging of Melanoma. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00123-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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14
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Annovazzi A, Ferraresi V, Rea S, Russillo M, Renna D, Carpano S, Sciuto R. Prognostic value of total metabolic tumour volume and therapy-response assessment by [ 18F]FDG PET/CT in patients with metastatic melanoma treated with BRAF/MEK inhibitors. Eur Radiol 2021; 32:3398-3407. [PMID: 34779873 DOI: 10.1007/s00330-021-08355-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/02/2021] [Accepted: 09/24/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Target therapy with BRAF/MEK inhibitors in metastatic melanoma is characterised by a high response rate; however, acquired resistance to treatment develops in many cases. We aimed to investigate if baseline total metabolic tumour volume (TMTV) and therapy-response assessment by [18F]FDG PET/CT have a prognostic role on progression-free survival (PFS) and overall survival (OS) in patients with metastatic melanoma receiving BRAF ± MEK inhibitors. METHODS Fifty-seven patients who performed an [18F]FDG PET/CT at baseline and on treatment were retrospectively evaluated. A Cox proportional-hazard model was used to examine associations between OS and PFS with baseline clinical/PET parameters as well as for PET response. RESULTS According to EORTC criteria, 34 patients were classified as responders (partial/complete metabolic response [PMR/CMR]) and 23 as non-responders (progressive/stable metabolic disease [PMD/SMD]). Baseline characteristics associated with a shorter PFS were more than two metastatic organ sites and TMTV > 56 cm3; the latter was the only independent feature at multivariate analysis. Patients achieving a CMR were associated with a prolonged PFS compared with those with PMR (median PFS 42.9 vs 8.8 months; p = 0.009). Disease progression occurred in new-onset disease sites in 87.5% of CMR, 7.1% of PMR and 34.8% of PMD/SMD (p < 0.001). High baseline TMTV and lack of treatment response were independent prognostic factors for OS, stratifying patients in three different prognostic classes (median OS 6.7, 18.3 and 102.2 months, respectively). CONCLUSIONS Baseline TMTV and metabolic response may be useful prognostic indicators for PFS and OS in patients with advanced melanoma treated with BRAF/MEK inhibitors. KEY POINTS • In a retrospective cohort of 57 metastatic melanoma patients treated with BRAF/MEK inhibitors, a TMTV > 56 cm3 at baseline [18F]FDG PET/CT was significantly correlated with a shorter PFS and OS. • The combined use of baseline TMTV along with PET response during treatment allowed for the identification of three groups of patients with very different median OS.
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Affiliation(s)
- Alessio Annovazzi
- Nuclear Medicine Unit, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy.
| | - Virginia Ferraresi
- First Division of Medical Oncology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
- Sarcomas and Rare Tumors Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Sandra Rea
- Nuclear Medicine Unit, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy
| | - Michelangelo Russillo
- First Division of Medical Oncology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Davide Renna
- First Division of Medical Oncology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Silvia Carpano
- Second Division of Medical Oncology, IRCCS - Regina Elena National Cancer Institute, Rome, Italy
| | - Rosa Sciuto
- Nuclear Medicine Unit, IRCCS - Regina Elena National Cancer Institute, Via Elio Chianesi, 53, 00144, Rome, Italy
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15
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Liberini V, Rubatto M, Mimmo R, Passera R, Ceci F, Fava P, Tonella L, Polverari G, Lesca A, Bellò M, Arena V, Ribero S, Quaglino P, Deandreis D. Predictive Value of Baseline [18F]FDG PET/CT for Response to Systemic Therapy in Patients with Advanced Melanoma. J Clin Med 2021; 10:jcm10214994. [PMID: 34768517 PMCID: PMC8584809 DOI: 10.3390/jcm10214994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 12/24/2022] Open
Abstract
Background/Aim: To evaluate the association between baseline [18F]FDG-PET/CT tumor burden parameters and disease progression rate after first-line target therapy or immunotherapy in advanced melanoma patients. Materials and Methods: Forty four melanoma patients, who underwent [18F]FDG-PET/CT before first-line target therapy (28/44) or immunotherapy (16/44), were retrospectively analyzed. Whole-body and per-district metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were calculated. Therapy response was assessed according to RECIST 1.1 on CT scan at 3 (early) and 12 (late) months. PET parameters were compared using the Mann–Whitney test. Optimal cut-offs for predicting progression were defined using the ROC curve. PFS and OS were studied using Kaplan–Meier analysis. Results: Median (IQR) MTVwb and TLGwb were 13.1 mL and 72.4, respectively. Non-responder patients were 38/44, 26/28 and 12/16 at early evaluation, and 33/44, 21/28 and 12/16 at late evaluation in the whole-cohort, target, and immunotherapy subgroup, respectively. At late evaluation, MTVbone and TLGbone were higher in non-responders compared to responder patients (all p < 0.037) in the whole-cohort and target subgroup and MTVwb and TLGwb (all p < 0.022) in target subgroup. No significant differences were found for the immunotherapy subgroup. No metabolic parameters were able to predict PFS. Controversially, MTVlfn, TLGlfn, MTVsoft + lfn, TLGsoft + lfn, MTVwb and TLGwb were significantly associated (all p < 0.05) with OS in both the whole-cohort and target therapy subgroup. Conclusions: Higher values of whole-body and bone metabolic parameters were correlated with poorer outcome, while higher values of whole-body, lymph node and soft tissue metabolic parameters were correlated with OS.
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Affiliation(s)
- Virginia Liberini
- Department of Medical Science, Division of Nuclear Medicine, University of Turin, 10126 Torino, Italy; (R.P.); (G.P.); (A.L.); (M.B.); (D.D.)
- Nuclear Medicine Department, S. Croce e Carle Hospital, 12100 Cuneo, Italy
- Correspondence:
| | - Marco Rubatto
- Department of Medical Sciences, Section of Dermatology, University of Turin, C.so Dogliotti, 10126 Torino, Italy; (M.R.); (P.F.); (L.T.); (S.R.); (P.Q.)
| | - Riccardo Mimmo
- Department of Medical Science, University of Turin, 10126 Torino, Italy;
| | - Roberto Passera
- Department of Medical Science, Division of Nuclear Medicine, University of Turin, 10126 Torino, Italy; (R.P.); (G.P.); (A.L.); (M.B.); (D.D.)
| | - Francesco Ceci
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Paolo Fava
- Department of Medical Sciences, Section of Dermatology, University of Turin, C.so Dogliotti, 10126 Torino, Italy; (M.R.); (P.F.); (L.T.); (S.R.); (P.Q.)
| | - Luca Tonella
- Department of Medical Sciences, Section of Dermatology, University of Turin, C.so Dogliotti, 10126 Torino, Italy; (M.R.); (P.F.); (L.T.); (S.R.); (P.Q.)
| | - Giulia Polverari
- Department of Medical Science, Division of Nuclear Medicine, University of Turin, 10126 Torino, Italy; (R.P.); (G.P.); (A.L.); (M.B.); (D.D.)
- PET Center, Affidea IRMET, 10135 Torino, Italy;
| | - Adriana Lesca
- Department of Medical Science, Division of Nuclear Medicine, University of Turin, 10126 Torino, Italy; (R.P.); (G.P.); (A.L.); (M.B.); (D.D.)
| | - Marilena Bellò
- Department of Medical Science, Division of Nuclear Medicine, University of Turin, 10126 Torino, Italy; (R.P.); (G.P.); (A.L.); (M.B.); (D.D.)
| | | | - Simone Ribero
- Department of Medical Sciences, Section of Dermatology, University of Turin, C.so Dogliotti, 10126 Torino, Italy; (M.R.); (P.F.); (L.T.); (S.R.); (P.Q.)
| | - Pietro Quaglino
- Department of Medical Sciences, Section of Dermatology, University of Turin, C.so Dogliotti, 10126 Torino, Italy; (M.R.); (P.F.); (L.T.); (S.R.); (P.Q.)
| | - Désirée Deandreis
- Department of Medical Science, Division of Nuclear Medicine, University of Turin, 10126 Torino, Italy; (R.P.); (G.P.); (A.L.); (M.B.); (D.D.)
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16
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Czepczyński R, Szczurek J, Mackiewicz J, Ruchała M. Interference of COVID-19 Vaccination With PET/CT Leads to Unnecessary Additional Imaging in a Patient With Metastatic Cutaneous Melanoma-Case Report. Front Oncol 2021; 11:690443. [PMID: 34414110 PMCID: PMC8369477 DOI: 10.3389/fonc.2021.690443] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022] Open
Abstract
The COVID-19 pandemic has widely influenced oncological imaging mainly by presenting unexpected pulmonary and mediastinal lesions. The ongoing global program of vaccination has led to incidental diagnosis of axillary lymphadenopathy. We present a case of increased accumulation of 18F-FDG in an axillary lymph node in a PET/CT scan performed in a 43-year-old female patient with metastatic melanoma. The scan was performed 4 days after the AZD1222 vaccination. The occurrence of lymphadenopathy was verified with another PET/CT scan scheduled one month later. This case report presents a possible misinterpretation of PET/CT images caused by the recent COVID-19 vaccination. To avoid distress of the patient and unnecessary oncological diagnostics to verify the findings, we recommend avoiding scheduling PET/CT shortly after vaccination.
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Affiliation(s)
- Rafał Czepczyński
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland.,Department of Nuclear Medicine, Affidea, Poznań, Poland
| | - Jolanta Szczurek
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland.,Department of Nuclear Medicine, Affidea, Poznań, Poland
| | - Jacek Mackiewicz
- Department of Medical and Experimental Oncology, Poznan University of Medical Sciences, Poznań, Poland
| | - Marek Ruchała
- Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland
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17
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Bratteby K, Shalgunov V, Herth MM. Aliphatic 18 F-Radiofluorination: Recent Advances in the Labeling of Base-Sensitive Substrates*. ChemMedChem 2021; 16:2612-2622. [PMID: 34169672 DOI: 10.1002/cmdc.202100303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Indexed: 12/19/2022]
Abstract
Aliphatic fluorine-18 radiolabeling is the most commonly used method to synthesize tracers for PET-imaging. With an increasing demand for 18 F-radiotracers for clinical applications, new labeling strategies aiming to increase radiochemical yields of established tracers or, more importantly, to enable 18 F-labeling of new scaffolds have been developed. In recent years, increased attention has been focused on the direct aliphatic 18 F-fluorination of base-sensitive substrates in this respect. This minireview gives a concise overview of the recent advances within this field and aims to highlight the advantages and limitations of these methods.
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Affiliation(s)
- Klas Bratteby
- Department of Drug Design and Pharmacology Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, 2100, Copenhagen, Denmark.,Department of Radiation Physics, Skåne University Hospital, Barngatan 3, 222 42, Lund, Sweden.,Department of Clinical Physiology, Nuclear Medicine & PET Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Vladimir Shalgunov
- Department of Drug Design and Pharmacology Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, 2100, Copenhagen, Denmark
| | - Matthias Manfred Herth
- Department of Drug Design and Pharmacology Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, 2100, Copenhagen, Denmark.,Department of Clinical Physiology, Nuclear Medicine & PET Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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18
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Van de Wiele C, Juanito G, Vander BK, Lawal I, De Spiegeleer B, Sathekge M, Maes A. Practical Considerations When Interpreting FDG PET/CT Imaging for Staging and Treatment Response Assessment in Melanoma Patients. Semin Nucl Med 2021; 51:544-553. [PMID: 34246450 DOI: 10.1053/j.semnuclmed.2021.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
While FDG PET/CT bears a high sensitivity and specificity for the staging of stage III and IV melanoma as well as for the purpose of melanoma recurrence detection, overall results tend to vary from one part of the body to another as well as for melanoma from cutaneous or choroidal origin. In this paper, organ or site-related differences in sensitivity and specificity in melanoma patients, both from cutaneous and choroidal origin, as well as their impact on clinical decision making are discussed. Furthermore, with the advent of immunotherapy for the treatment of malignant melanoma, post-treatment related potential false positive findings have emerged, the knowledge of which is essential for accurate treatment response assessment. These post-treatment related potential false positive findings are summarized in this paper so as to help the nuclear medicine physician in avoiding erroneous interpretation of acquired FDG PET/CT images in melanoma patients receiving immuntherapy.
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Affiliation(s)
- Christophe Van de Wiele
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium; Department of Diagnostic Sciences, University Ghent, Ghent, Belgium.
| | | | - Borght K Vander
- DRUQUAR, Laboratory of Drug Quality and Registration, Department of Pharmaceutical Sciences, University Ghent, Ghent, Belgium
| | - Ismaheel Lawal
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South-Africa
| | - Bart De Spiegeleer
- DRUQUAR, Laboratory of Drug Quality and Registration, Department of Pharmaceutical Sciences, University Ghent, Ghent, Belgium
| | - Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South-Africa
| | - Alex Maes
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium; Department of Morphological Sciences, University Leuven, Leuven, Belgium
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19
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Kudura K, Dimitriou F, Mihic-Probst D, Muehlematter UJ, Kutzker T, Basler L, Förster R, Dummer R, Mangana J, Husmann L, Burger IA, Kreissl MC. Malignancy Rate of Indeterminate Findings on FDG-PET/CT in Cutaneous Melanoma Patients. Diagnostics (Basel) 2021; 11:diagnostics11050883. [PMID: 34063555 PMCID: PMC8156636 DOI: 10.3390/diagnostics11050883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The use of 18F-2-Fluor-2-desoxy-D-glucose Positron Emission Tomography/Computed Tomography FDG-PET/CT in clinical routine for staging, treatment response monitoring and post treatment surveillance in metastatic melanoma patients has noticeably increased due to significant improvement of the overall survival rate in melanoma patients. However, determining the dignity of the findings with increased metabolic activity on FDG-PET/CT can be sometimes challenging and may need further investigation. PURPOSE We aimed to investigate the malignancy rate of indeterminate findings on FDG-PET/CT in metastatic cutaneous melanoma patients. METHODS This single-center retrospective study included cutaneous melanoma patients who underwent FDG-PET/CT in clinical routine between 2015 and 2017 with findings reported as indeterminate and therefore requiring further evaluation. The dignity of the included findings was determined by subsequent imaging and, if required, additional histopathology. The impact of the outcome on the clinical management was also reported. RESULTS A total of 842 FDG-PET/CT reports of 244 metastatic cutaneous melanoma patients were reviewed. Sixty indeterminate findings were included. Almost half of all indeterminate findings were lymph nodes, lung nodules and cerebral lesions. In total, 43.3% of all included findings proved to be malignant. 81% of all malignant lesions were metastases of cutaneous melanoma, while 19% of all malignant lesions could be attributed to other primary malignancies, such as lung, breast, thyroid and colorectal cancers. Malignant findings influenced clinical management in 60% of the cases. CONCLUSION Indeterminate findings on FDG-PET/CT in metastatic cutaneous melanoma patients should be further investigated. Almost one out of every two indeterminate findings on FDG-PET/CT is malignant. The majority of the findings are melanoma manifestations, however, in a significant percentage, other primary tumors are found. Upon verification, patient management is changed in most cases.
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Affiliation(s)
- Ken Kudura
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland; (U.J.M.); (L.H.); (I.A.B.)
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Correspondence:
| | - Florentia Dimitriou
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Daniela Mihic-Probst
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Urs J. Muehlematter
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland; (U.J.M.); (L.H.); (I.A.B.)
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
| | - Tim Kutzker
- Faculty of Applied Statistics, Humboldt University Berlin, 10117 Berlin, Germany;
| | - Lucas Basler
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Robert Förster
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Institute of Radiation Oncology, Cantonal Hospital Winterthur, 8400 Winterthur, Switzerland
| | - Reinhard Dummer
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Joanna Mangana
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
- Department of Dermatology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Lars Husmann
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland; (U.J.M.); (L.H.); (I.A.B.)
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
| | - Irene A. Burger
- Department of Nuclear Medicine, University Hospital Zurich, 8006 Zurich, Switzerland; (U.J.M.); (L.H.); (I.A.B.)
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland; (F.D.); (D.M.-P.); (L.B.); (R.F.); (R.D.); (J.M.)
| | - Michael Christoph Kreissl
- Division of Nuclear Medicine, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany;
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20
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Early Reassessment of Total Metabolic Tumor Volume on FDG-PET/CT in Advanced Melanoma Patients Treated with Pembrolizumab Predicts Long-Term Outcome. ACTA ACUST UNITED AC 2021; 28:1630-1640. [PMID: 33925392 PMCID: PMC8161820 DOI: 10.3390/curroncol28030152] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/19/2021] [Accepted: 04/24/2021] [Indexed: 12/26/2022]
Abstract
PD-1 Immune checkpoint inhibitors, such as Pembrolizumab, can have a durable beneficial therapeutic effect in patients with advanced melanoma. However, not all patients will benefit equally from these therapies, and (potentially life-threatening) immune-related adverse events may occur. In this study, we investigate the value of early response assessment by FDG-PET/CT as a biomarker for predicting survival. We identified all patients with advanced melanoma who were treated with Pembrolizumab in our medical center and underwent a baseline and at least one follow-up FDG-PET/CT. The total metabolic tumor volume (TMTV) was calculated, and the evolution was compared to survival parameters. A total of 77 patients underwent a baseline and at least one follow-up FDG-PET/CT, 36 patients had follow-up imaging within 2–4 months, and 21 patients an FDG-PET/CT 5–6 months after baseline. When the TMTV evolution was categorized into two subgroups (stable/decrease versus increase), an association was found between stability or decrease in TMTV and better PFS and OS. A similar trend, however non-significant, was observed at 5–6 months. The evolution in TMTV as assessed by FDG-PET/CT 2–4 months after treatment initiation is associated with long-term outcomes in patients with advanced melanoma treated with Pembrolizumab.
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21
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Franklin C, Wetter A, Baba HA, Theysohn J, Haubold J, Cosgarea I, Hadaschik E, Livingstone E, Zimmer L, Stoffels I, Klode J, Lodde G, Placke JM, Schadendorf D, Ugurel S. Computed tomography-guided biopsy of radiologically unclear lesions in advanced skin cancer: A retrospective analysis of 47 cases. Eur J Cancer 2021; 150:119-129. [PMID: 33895683 DOI: 10.1016/j.ejca.2021.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 03/08/2021] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Radiological imaging such as computed tomography (CT) is used frequently for disease staging and therapy monitoring in advanced skin cancer patients. Detected lesions of unclear dignity are a common challenge for treating physicians. The aim of this study was to assess the frequency and outcome of CT-guided biopsy (CTGB) of radiologically unclear, suspicious lesions and to depict its usefulness in different clinical settings. METHODS This retrospective monocentric study included advanced skin cancer patients (melanoma, Merkel cell carcinoma, squamous cell carcinoma, angiosarcoma, cutaneous lymphoma) with radiologically unclear lesions who underwent CTGB between 2010 and 2018. RESULTS Of 59 skin cancer patients who received CTGB, 47 received CTGB to clarify radiologically suspicious lesions of unclear dignity. 32 patients had no systemic therapy (cohort A), while 15 patients received systemic treatment at CTGB (cohort B). In both cohorts, CTGB revealed skin cancer metastasis in a large proportion of patients (37.5%, 40.0%, respectively), but benign tissue showing inflammation, fibrosis or infection in an equally large percentage (37.5%, 46.7%, respectively). Additionally, a significant number of other cancer entities was found (25.0%, 13.3%, respectively). In patients receiving BRAF/MEK inhibitors, CTGB confirmed suspicious lesions as skin cancer metastasis in 83.3%, leading to treatment change. In immune checkpoint inhibitor-treated patients, skin cancer metastasis was confirmed in 11.1% of patients only, whereas benign tissue changes (inflammation/fibrosis) were found in 77.8%. CONCLUSIONS Our results highlight the relevance of clarifying radiologically unclear lesions by CTGB before start or change of an anti-tumour therapy to exclude benign alterations and secondary malignancies.
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Affiliation(s)
- Cindy Franklin
- Department of Dermatology, Venereology and Allergology, University Hospital Cologne, Cologne, Germany.
| | - Axel Wetter
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Hideo Andreas Baba
- Institute of Pathology, University Hospital Essen, Essen, Germany; German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Jens Theysohn
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Johannes Haubold
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Ioana Cosgarea
- Newcastle Upon Thyne Hospitals NHS Trust, Newcastle Oncology and Dermatology, Newcastle Upon Thyne, United Kingdom
| | - Eva Hadaschik
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany; German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Elisabeth Livingstone
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany; German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Lisa Zimmer
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany; German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Ingo Stoffels
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany; German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Joachim Klode
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany; German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Georg Lodde
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany; German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Jan-Malte Placke
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany; German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Dirk Schadendorf
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany; German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
| | - Selma Ugurel
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, Essen, Germany; German Consortium for Translational Cancer Research, Partner Site University Hospital Essen, Essen, Germany
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22
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Liberini V, Messerli M, Husmann L, Kudura K, Grünig H, Maurer A, Skawran S, Orita E, Pizzuto DA, Deandreis D, Dummer R, Mangana J, Mihic-Probst D, Rupp N, Huellner MW. Improved detection of in-transit metastases of malignant melanoma with BSREM reconstruction in digital [ 18F]FDG PET/CT. Eur Radiol 2021; 31:8011-8020. [PMID: 33768288 PMCID: PMC8452544 DOI: 10.1007/s00330-021-07852-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare block sequential regularized expectation maximization (BSREM) and ordered subset expectation maximization (OSEM) for the detection of in-transit metastasis (ITM) of malignant melanoma in digital [18F]FDG PET/CT. METHODS We retrospectively analyzed a cohort of 100 [18F]FDG PET/CT scans of melanoma patients with ITM, performed between May 2017 and January 2020. PET images were reconstructed with both OSEM and BSREM algorithms. SUVmax, target-to-background ratio (TBR), and metabolic tumor volume (MTV) were recorded for each ITM. Differences in PET parameters were analyzed with the Wilcoxon signed-rank test. Differences in image quality for different reconstructions were tested using the Man-Whitney U test. RESULTS BSREM reconstruction led to the detection of 287 ITM (39% more than OSEM). PET parameters of ITM were significantly different between BSREM and OSEM reconstructions (p < 0.001). SUVmax and TBR were higher (76.5% and 77.7%, respectively) and MTV lower (49.5%) on BSREM. ITM missed with OSEM had significantly lower SUVmax (mean 2.03 vs. 3.84) and TBR (mean 1.18 vs. 2.22) and higher MTV (mean 2.92 vs. 1.01) on OSEM compared to BSREM (all p < 0.001). CONCLUSIONS BSREM detects significantly more ITM than OSEM, owing to higher SUVmax, higher TBR, and less blurring. BSREM is particularly helpful in small and less avid lesions, which are more often missed with OSEM. KEY POINTS • In melanoma patients, [18F]FDG PET/CT helps to detect in-transit metastases (ITM), and their detection is improved by using BSREM instead of OSEM reconstruction. • BSREM is particularly useful in small lesions.
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Affiliation(s)
- Virginia Liberini
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland.
- Department of Nuclear Medicine, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy.
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland
| | - Lars Husmann
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland
| | - Ken Kudura
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland
| | - Hannes Grünig
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland
| | - Alexander Maurer
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland
| | - Stephan Skawran
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland
| | - Erika Orita
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland
- Department of Radiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Daniele A Pizzuto
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland
- Nuclear Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | - Désirée Deandreis
- Department of Nuclear Medicine, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Reinhard Dummer
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Joanna Mangana
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniela Mihic-Probst
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niels Rupp
- Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Martin W Huellner
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, CH-8091, Zürich, Switzerland
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23
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Jiménez-Sánchez J, Bosque JJ, Jiménez Londoño GA, Molina-García D, Martínez Á, Pérez-Beteta J, Ortega-Sabater C, Honguero Martínez AF, García Vicente AM, Calvo GF, Pérez-García VM. Evolutionary dynamics at the tumor edge reveal metabolic imaging biomarkers. Proc Natl Acad Sci U S A 2021; 118:e2018110118. [PMID: 33536339 PMCID: PMC8017959 DOI: 10.1073/pnas.2018110118] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/04/2021] [Indexed: 01/09/2023] Open
Abstract
Human cancers are biologically and morphologically heterogeneous. A variety of clonal populations emerge within these neoplasms and their interaction leads to complex spatiotemporal dynamics during tumor growth. We studied the reshaping of metabolic activity in human cancers by means of continuous and discrete mathematical models and matched the results to positron emission tomography (PET) imaging data. Our models revealed that the location of increasingly active proliferative cellular spots progressively drifted from the center of the tumor to the periphery, as a result of the competition between gradually more aggressive phenotypes. This computational finding led to the development of a metric, normalized distance from 18F-fluorodeoxyglucose (18F-FDG) hotspot to centroid (NHOC), based on the separation from the location of the activity (proliferation) hotspot to the tumor centroid. The NHOC metric can be computed for patients using 18F-FDG PET-computed tomography (PET/CT) images where the voxel of maximum uptake (standardized uptake value [SUV]max) is taken as the activity hotspot. Two datasets of 18F-FDG PET/CT images were collected, one from 61 breast cancer patients and another from 161 non-small-cell lung cancer patients. In both cohorts, survival analyses were carried out for the NHOC and for other classical PET/CT-based biomarkers, finding that the former had a high prognostic value, outperforming the latter. In summary, our work offers additional insights into the evolutionary mechanisms behind tumor progression, provides a different PET/CT-based biomarker, and reveals that an activity hotspot closer to the tumor periphery is associated to a worst patient outcome.
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Affiliation(s)
- Juan Jiménez-Sánchez
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, 13071, Spain
| | - Jesús J Bosque
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, 13071, Spain
| | | | - David Molina-García
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, 13071, Spain
| | - Álvaro Martínez
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, 13071, Spain
- Nuclear Medicine Unit, Hospital General Universitario de Ciudad Real, Ciudad Real, 13005, Spain
| | - Julián Pérez-Beteta
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, 13071, Spain
| | - Carmen Ortega-Sabater
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, 13071, Spain
| | | | - Ana M García Vicente
- Thoracic Surgery Unit, Hospital General Universitario de Albacete, Albacete, 02006, Spain
| | - Gabriel F Calvo
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, 13071, Spain;
| | - Víctor M Pérez-García
- Mathematical Oncology Laboratory, Universidad de Castilla-La Mancha, Ciudad Real, 13071, Spain;
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24
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van Sluis J, de Heer EC, Boellaard M, Jalving M, Brouwers AH, Boellaard R. Clinically feasible semi-automatic workflows for measuring metabolically active tumour volume in metastatic melanoma. Eur J Nucl Med Mol Imaging 2020; 48:1498-1510. [PMID: 33099667 PMCID: PMC8113298 DOI: 10.1007/s00259-020-05068-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022]
Abstract
Purpose Metabolically active tumour volume (MATV) is a potential quantitative positron emission tomography (PET) imaging biomarker in melanoma. Accumulating data indicate that low MATV may predict increased chance of response to immunotherapy and overall survival. However, metastatic melanoma can present with numerous (small) tumour lesions, making manual tumour segmentation time-consuming. The aim of this study was to evaluate multiple semi-automatic segmentation workflows to determine reliability and reproducibility of MATV measurements in patients with metastatic melanoma. Methods An existing cohort of 64 adult patients with histologically proven metastatic melanoma was used in this study. 18F-FDG PET/CT diagnostic baseline images were acquired using a European Association of Nuclear Medicine (EANM) Research Limited–accredited Siemens Biograph mCT PET/CT system (Siemens Healthineers, Knoxville, USA). PET data were analysed using manual, gradient-based segmentation and five different semi-automatic methods: three direct PET image–derived delineations (41MAX, A50P and SUV40) and two based on a majority-vote approach (MV2 and MV3), without and with (suffix ‘+’) manual lesion addition. Correlation between the different segmentation methods and their respective associations with overall survival was assessed. Results Correlation between the MATVs derived by the manual segmentation and semi-automated tumour segmentations ranged from R2 = 0.41 for A50P to R2 = 0.85 for SUV40+ and MV2+, respectively. Manual MATV segmentation did not differ significantly from the semi-automatic methods SUV40 (∆MATV mean ± SD 0.08 ± 0.60 mL, P = 0.303), SUV40+ (∆MATV − 0.10 ± 0.51 mL, P = 0.126), MV2+ (∆MATV − 0.09 ± 0.62 mL, P = 0.252) and MV3+ (∆MATV − 0.03 ± 0.55 mL, P = 0.615). Log-rank tests showed statistically significant overall survival differences between above and below median MATV patients for all segmentation methods with areas under the ROC curves of 0.806 for manual segmentation and between 0.756 [41MAX] and 0.807 [MV3+] for semi-automatic segmentations. Conclusions Simple and fast semi-automated FDG PET segmentation workflows yield accurate and reproducible MATV measurements that correlate well with manual segmentation in metastatic melanoma. The most readily applicable and user-friendly SUV40 method allows feasible MATV measurement in prospective multicentre studies required for validation of this potential PET imaging biomarker for clinical use. Electronic supplementary material The online version of this article (10.1007/s00259-020-05068-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joyce van Sluis
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - Ellen C de Heer
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Mayke Boellaard
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - Mathilde Jalving
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - Ronald Boellaard
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands. .,Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Cancer Center Amsterdam UMC, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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25
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Malapelle U, Rossi G, Pisapia P, Barberis M, Buttitta F, Castiglione F, Cecere FL, Grimaldi AM, Iaccarino A, Marchetti A, Massi D, Medicina D, Mele F, Minari R, Orlando E, Pagni F, Palmieri G, Righi L, Russo A, Tommasi S, Vermi W, Troncone G. BRAF as a positive predictive biomarker: Focus on lung cancer and melanoma patients. Crit Rev Oncol Hematol 2020; 156:103118. [PMID: 33038627 DOI: 10.1016/j.critrevonc.2020.103118] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 02/06/2023] Open
Abstract
In the era of personalized medicine, BRAF mutational assessment is mandatory in advanced-stage melanoma and non-small cell lung cancer (NSCLC) patients. The identification of actionable mutations is crucial for the adequate management of these patients. To date various drugs have been implemented in clinical practice. Similarly, various methods may be adopted for the identification of BRAF mutations. Here, we briefly review the current literature on BRAF in melanoma and NSCLC, focusing attention in particular on the different methods and drugs adopted in these patients. In addition, an overview of the real-world practice in different Italian laboratories with high expertise in molecular predictive pathology testing is provided.
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Affiliation(s)
- Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giulio Rossi
- Pathology Unit, Azienda USL Romagna, St. Maria delle Croci Hospital, Ravenna, Italy
| | - Pasquale Pisapia
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Massimo Barberis
- Unit of Histopathology and Molecular Diagnostics, European Institute of Oncology IRCCS, Milano, Italy
| | - Fiamma Buttitta
- Center for Advanced Studies and Technology (CAST) - Department of Medical, Oral and Biotechnological Sciences, University of Chieti, Italy
| | - Francesca Castiglione
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Antonio Maria Grimaldi
- Unit of Melanoma, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | - Antonino Iaccarino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Antonio Marchetti
- Center for Advanced Studies and Technology (CAST) - Department of Medical, Oral and Biotechnological Sciences, University of Chieti, Italy
| | - Daniela Massi
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Daniela Medicina
- Section of Pathology, Asst Spedali Civili di Brescia, Brescia, Italy
| | - Fabio Mele
- Pathology Department, IRCCS-Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - Roberta Minari
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Elisabetta Orlando
- Department of Health Promotion, Mother and Child care, Internal Medicine and Medical Specialties (ProMISE), Unit of Anatomic Pathology, University of Palermo, Palermo, Italy
| | - Fabio Pagni
- Department of Medicine and Surgery, Pathology, University Milan Bicocca, Milan, Italy
| | - Giuseppe Palmieri
- Unit of Cancer Genetics, Institute of Genetic and Biomedical Research (IRGB), National Research Council (CNR), Sassari, Italy
| | - Luisella Righi
- Department of Oncology, San Luigi Hospital, University of Turin, Turin, Italy
| | | | - Stefania Tommasi
- Pathology Department, IRCCS-Istituto Tumori 'Giovanni Paolo II', Bari, Italy
| | - William Vermi
- Section of Pathology, Asst Spedali Civili di Brescia, Brescia, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Naples, Italy.
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