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Llombart-Cussac A, Prat A, Pérez-García JM, Mateos J, Pascual T, Escrivà-de-Romani S, Stradella A, Ruiz-Borrego M, de Las Heras BB, Keyaerts M, Galvan P, Brasó-Maristany F, García-Mosquera JJ, Guiot T, Gion M, Sampayo-Cordero M, Di Cosimo S, Pérez-Escuredo J, de Frutos MA, Cortés J, Gebhart G. Clinicopathological and molecular predictors of [ 18F]FDG-PET disease detection in HER2-positive early breast cancer: RESPONSE, a substudy of the randomized PHERGain trial. Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06683-0. [PMID: 38587643 DOI: 10.1007/s00259-024-06683-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/10/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND The PHERGain study (NCT03161353) is assessing early metabolic responses to neoadjuvant treatment with trastuzumab-pertuzumab and chemotherapy de-escalation using a [18Fluorine]fluorodeoxyglucose-positron emission tomography ([18F]FDG-PET) and a pathological complete response-adapted strategy in HER2-positive (HER2+) early breast cancer (EBC). Herein, we present RESPONSE, a PHERGain substudy, where clinicopathological and molecular predictors of [18F]FDG-PET disease detection were evaluated. METHODS A total of 500 patients with HER2 + EBC screened in the PHERGain trial with a tumor size > 1.5 cm by magnetic resonance imaging (MRI) were included in the RESPONSE substudy. PET[-] criteria entailed the absence of ≥ 1 breast lesion with maximum standardized uptake value (SUVmax) ≥ 1.5 × SUVmean liver + 2 standard deviation. Among 75 PET[-] patients screened, 21 with SUVmax levels < 2.5 were randomly selected and matched with 21 PET[+] patients with SUVmax levels ≥ 2.5 based on patient characteristics associated with [18F]FDG-PET status. The association between baseline SUVmax and [18F]FDG-PET status ([-] or [+]) with clinicopathological characteristics was assessed. In addition, evaluation of stromal tumor-infiltrating lymphocytes (sTILs) and gene expression analysis using PAM50 and Vantage 3D™ Cancer Metabolism Panel were specifically compared in a matched cohort of excluded and enrolled patients based on the [18F]FDG-PET eligibility criteria. RESULTS Median SUVmax at baseline was 7.2 (range, 1-39.3). Among all analyzed patients, a higher SUVmax was associated with a higher tumor stage, larger tumor size, lymph node involvement, hormone receptor-negative status, higher HER2 protein expression, increased Ki67 proliferation index, and higher histological grade (p < 0.05). [18F]FDG-PET [-] criteria patients had smaller tumor size (p = 0.014) along with the absence of lymph node involvement and lower histological grade than [18F]FDG-PET [+] patients (p < 0.01). Although no difference in the levels of sTILs was found among 42 matched [18F]FDG-PET [-]/[+] criteria patients (p = 0.73), [18F]FDG-PET [-] criteria patients showed a decreased risk of recurrence (ROR) and a lower proportion of PAM50 HER2-enriched subtype than [18F]FDG-PET[+] patients (p < 0.05). Differences in the expression of genes involved in cancer metabolism were observed between [18F]FDG-PET [-] and [18F]FDG-PET[+] criteria patients. CONCLUSIONS These results highlight the clinical, biological, and metabolic heterogeneity of HER2+ breast cancer, which may facilitate the selection of HER2+ EBC patients likely to benefit from [18F]FDG-PET imaging as a tool to guide therapy. TRIAL REGISTRATION Clinicaltrials.gov; NCT03161353; registration date: May 15, 2017.
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Affiliation(s)
- Antonio Llombart-Cussac
- Hospital Arnau de Vilanova, FISABIO, Valencia, Spain.
- Universidad Católica de Valencia, Valencia, Spain.
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain.
| | - Aleix Prat
- Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- Translational Genomics and Targeted Therapies in Solid Tumors Lab., Barcelona, Spain
| | - José Manuel Pérez-García
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain
- International Breast Cancer Center, Pangea Oncology, QuironSalud Group, Barcelona, Spain
| | | | - Tomás Pascual
- Hospital Clínic i Provincial de Barcelona, Barcelona, Spain
| | | | | | | | | | | | - Patricia Galvan
- Translational Genomics and Targeted Therapies in Solid Tumors Lab., Barcelona, Spain
| | - Fara Brasó-Maristany
- Translational Genomics and Targeted Therapies in Solid Tumors Lab., Barcelona, Spain
| | - Juan José García-Mosquera
- Dr. Rosell Oncology Institute (IOR), Dexeus University Hospital, Pangaea Oncology, Quironsalud Group, Barcelona, Spain
| | - Thomas Guiot
- Université Libre de Bruxelles, Hôpital Universitaire de Bruxelles, Institute Jules Bordet, Brussels, Belgium
| | | | | | | | | | - Manuel Atienza de Frutos
- Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Medicine, Madrid, Spain
| | - Javier Cortés
- Universidad Católica de Valencia, Valencia, Spain
- International Breast Cancer Center, Pangea Oncology, QuironSalud Group, Barcelona, Spain
- Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Medicine, Madrid, Spain
| | - Geraldine Gebhart
- Université Libre de Bruxelles, Hôpital Universitaire de Bruxelles, Institute Jules Bordet, Brussels, Belgium
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Kataoka M, Iima M, Miyake KK, Honda M. Multiparametric Approach to Breast Cancer With Emphasis on Magnetic Resonance Imaging in the Era of Personalized Breast Cancer Treatment. Invest Radiol 2024; 59:26-37. [PMID: 37994113 DOI: 10.1097/rli.0000000000001044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
ABSTRACT A multiparametric approach to breast cancer imaging offers the advantage of integrating the diverse contributions of various parameters. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is the most important MRI sequence for breast imaging. The vascularity and permeability of lesions can be estimated through the use of semiquantitative and quantitative parameters. The increased use of ultrafast DCE-MRI has facilitated the introduction of novel kinetic parameters. In addition to DCE-MRI, diffusion-weighted imaging provides information associated with tumor cell density, with advanced diffusion-weighted imaging techniques such as intravoxel incoherent motion, diffusion kurtosis imaging, and time-dependent diffusion MRI opening up new horizons in microscale tissue evaluation. Furthermore, T2-weighted imaging plays a key role in measuring the degree of tumor aggressiveness, which may be related to the tumor microenvironment. Magnetic resonance imaging is, however, not the only imaging modality providing semiquantitative and quantitative parameters from breast tumors. Breast positron emission tomography demonstrates superior spatial resolution to whole-body positron emission tomography and allows comparable delineation of breast cancer to MRI, as well as providing metabolic information, which often precedes vascular and morphological changes occurring in response to treatment. The integration of these imaging-derived factors is accomplished through multiparametric imaging. In this article, we explore the relationship among the key imaging parameters, breast cancer diagnosis, and histological characteristics, providing a technical and theoretical background for these parameters. Furthermore, we review the recent studies on the application of multiparametric imaging to breast cancer and the significance of the key imaging parameters.
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Affiliation(s)
- Masako Kataoka
- From the Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine Kyoto University, Kyoto, Japan (M.K., M.I., M.H.); Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan (M.I.); Department of Advanced Imaging in Medical Magnetic Resonance, Graduate School of Medicine Kyoto University, Kyoto, Japan (K.K.M); and Department of Diagnostic Radiology, Kansai Electric Power Hospital, Osaka, Japan (M.H.)
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Cha J, Kim H, Shin HJ, Lee M, Jun S, Kang WJ, Cho A. Does high [ 18F]FDG uptake always mean poor prognosis? Colon cancer with high-level microsatellite instability is associated with high [ 18F]FDG uptake on PET/CT. Eur Radiol 2023; 33:7450-7460. [PMID: 37338560 DOI: 10.1007/s00330-023-09832-5] [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: 01/09/2023] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVES High-level microsatellite instability (MSI-high) is generally associated with higher F-18 fluorodeoxyglucose ([18F]FDG) uptake than stable microsatellite (MSI-stable) tumors. However, MSI-high tumors have better prognosis, which is in contrast with general understanding that high [18F]FDG uptake correlates with poor prognosis. This study evaluated metastasis incidence with MSI status and [18F]FDG uptake. METHODS We retrospectively reviewed 108 right-side colon cancer patients who underwent preoperative [18F]FDG PET/CT and postoperative MSI evaluations using a standard polymerase chain reaction at five Bethesda guidelines panel loci. The maximum standard uptake value (SUVmax), SUVmax tumor-to-liver ratio (TLR), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumor were measured using SUV 2.5 cut-off threshold. Student's t-test or Mann-Whitney U test was performed for continuous variables, and χ2 test or Fisher's exact test was performed for categorical variables (p value of < 0.05 for statistical significance). Medical records were reviewed for metastasis incidence. RESULTS Our study population had 66 MSI-stable and 42 MSI-high tumors. [18F]FDG uptake was higher in MSI-high tumors than MSI-stable tumors (TLR, median (Q1, Q3): 7.95 (6.06, 10.54) vs. 6.08 (4.09, 8.82), p = 0.021). Multivariable subgroup analysis demonstrated that higher [18F]FDG uptake was associated with higher risks of distant metastasis in MSI-stable tumors (SUVmax: p = 0.025, MTV: p = 0.008, TLG: p = 0.019) but not in MSI-high tumors. CONCLUSION MSI-high colon cancer is associated with high [18F]FDG uptake, but unlike MSI-stable tumors, the degree of [18F]FDG uptake does not correlate with the rate of distant metastasis. CLINICAL RELEVANCE STATEMENT MSI status should be considered during PET/CT assessment of colon cancer patients, as the degree of [18F]FDG uptake might not reflect metastatic potential in MSI-high tumors. KEY POINTS • High-level microsatellite instability (MSI-high) tumor is a prognostic factor for distant metastasis. • MSI-high colon cancers had a tendency of demonstrating higher [18F]FDG uptake compared to MSI-stable tumors. • Although higher [18F]FDG uptake is known to represent higher risks of distant metastasis, the degree of [18F]FDG uptake in MSI-high tumors did not correlate with the rate at which distant metastasis occurred.
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Affiliation(s)
- Jongtae Cha
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Honsoul Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Samsung Life Building (B, 7th floor) 115 Irwon-ro, Gangnam-gu, Seoul, 06355, Republic of Korea.
- Department of Health Science and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
| | - Hye Jung Shin
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeongjee Lee
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seowoong Jun
- Department of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Jun Kang
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Arthur Cho
- Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
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Mainta IC, Sfakianaki I, Shiri I, Botsikas D, Garibotto V. The Clinical Added Value of Breast Cancer Imaging Using Hybrid PET/MR Imaging. Magn Reson Imaging Clin N Am 2023; 31:565-577. [PMID: 37741641 DOI: 10.1016/j.mric.2023.06.007] [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] [Indexed: 09/25/2023]
Abstract
Dedicated MR imaging is highly performant for the evaluation of the primary lesion and should regularly be added to whole-body PET/MR imaging for the initial staging. PET/MR imaging is highly sensitive for the detection of nodal involvement and could be combined with the high specificity of axillary second look ultrasound for the confirmation of the N staging. For M staging, with the exception of lung lesions, PET/MR imaging is superior to PET/computed tomography, at half the radiation dose. The predictive value of multiparametric imaging with PET/MR imaging holds promise to improve through radiomics and artificial intelligence.
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Affiliation(s)
- Ismini C Mainta
- Department of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland.
| | - Ilektra Sfakianaki
- Department of Radiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland
| | - Isaac Shiri
- Department of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland
| | - Diomidis Botsikas
- Department of Radiology, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland
| | - Valentina Garibotto
- Department of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva 1205, Switzerland; Faculty of Medicine, University of Geneva, Rue Michel Servet 1, Geneva 1211, Switzerland
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Seban RD, Arnaud E, Loirat D, Cabel L, Cottu P, Djerroudi L, Hescot S, Loap P, Bonneau C, Bidard FC, Huchet V, Jehanno N, Berenbaum A, Champion L, Buvat I. [18F]FDG PET/CT for predicting triple-negative breast cancer outcomes after neoadjuvant chemotherapy with or without pembrolizumab. Eur J Nucl Med Mol Imaging 2023; 50:4024-4035. [PMID: 37606858 DOI: 10.1007/s00259-023-06394-y] [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: 05/22/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE To determine if pretreatment [18F]FDG PET/CT could contribute to predicting complete pathological complete response (pCR) in patients with early-stage triple-negative breast cancer (TNBC) undergoing neoadjuvant chemotherapy with or without pembrolizumab. METHODS In this retrospective bicentric study, we included TNBC patients who underwent [18F]FDG PET/CT before neoadjuvant chemotherapy (NAC) or chemo-immunotherapy (NACI) between March 2017 and August 2022. Clinical, biological, and pathological data were collected. Tumor SUVmax and total metabolic tumor volume (TMTV) were measured from the PET images. Cut-off values were determined using ROC curves and a multivariable model was developed using logistic regression to predict pCR. RESULTS N = 191 patients were included. pCR rates were 53 and 70% in patients treated with NAC (N = 91) and NACI (N = 100), respectively (p < 0.01). In univariable analysis, high Ki67, high tumor SUVmax (> 12.3), and low TMTV (≤ 3.0 cm3) were predictors of pCR in the NAC cohort while tumor staging classification (< T3), BRCA1/2 germline mutation, high tumor SUVmax (> 17.2), and low TMTV (≤ 7.3 cm3) correlated with pCR in the NACI cohort. In multivariable analysis, only high tumor SUVmax (NAC: OR 8.8, p < 0.01; NACI: OR 3.7, p = 0.02) and low TMTV (NAC: OR 6.6, p < 0.01; NACI: OR 3.5, p = 0.03) were independent factors for pCR in both cohorts, albeit at different thresholds. CONCLUSION High tumor metabolism (SUVmax) and low tumor burden (TMTV) could predict pCR after NAC regardless of the addition of pembrolizumab. Further studies are warranted to validate such findings and determine how these biomarkers could be used to guide neoadjuvant therapy in TNBC patients.
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Affiliation(s)
- Romain-David Seban
- Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, 92210, Saint-Cloud, France.
- Laboratoire d'Imagerie Translationnelle en Oncologie, Inserm U1288, Institut Curie, PSL University, Paris Saclay University, 91400, Orsay, France.
| | - Emilie Arnaud
- Department of Medical Oncology, Institut Curie, PSL Research University, 75005, Paris, France
| | - Delphine Loirat
- Department of Medical Oncology, Institut Curie, PSL Research University, 75005, Paris, France
| | - Luc Cabel
- Department of Medical Oncology, Institut Curie, PSL Research University, 75005, Paris, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, PSL Research University, 75005, Paris, France
| | | | - Segolene Hescot
- Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, 92210, Saint-Cloud, France
| | - Pierre Loap
- Department of Radiation Oncology, Institut Curie, 92210, Saint-Cloud, France
| | - Claire Bonneau
- Inserm U900, Institut Curie, 35, rue Dailly, 92210, Saint-Cloud, France
- Department of Surgery, Institut Curie, 92210, Saint-Cloud, France
| | - Francois-Clement Bidard
- Department of Medical Oncology, Institut Curie, UVSQ/Paris-Saclay University, 92210, Saint-Cloud, France
- Circulating Tumor Biomarkers Laboratory, Institut Curie, SiRIC, PSL Research University, Paris, France
| | - Virginie Huchet
- Department of Nuclear Medicine, Institut Curie, 75005, Paris, France
| | - Nina Jehanno
- Department of Nuclear Medicine, Institut Curie, 75005, Paris, France
| | - Arnaud Berenbaum
- Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, 92210, Saint-Cloud, France
| | - Laurence Champion
- Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, 92210, Saint-Cloud, France
- Laboratoire d'Imagerie Translationnelle en Oncologie, Inserm U1288, Institut Curie, PSL University, Paris Saclay University, 91400, Orsay, France
| | - Irene Buvat
- Laboratoire d'Imagerie Translationnelle en Oncologie, Inserm U1288, Institut Curie, PSL University, Paris Saclay University, 91400, Orsay, France
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Wu R, Jia Y, Li N, Lu X, Yao Z, Ma Y, Nie F. Evaluation of Breast Cancer Tumor-Infiltrating Lymphocytes on Ultrasound Images Based on a Novel Multi-Cascade Residual U-Shaped Network. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2398-2406. [PMID: 37634979 DOI: 10.1016/j.ultrasmedbio.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/30/2023] [Accepted: 08/04/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE Breast cancer has become the leading cancer of the 21st century. Tumor-infiltrating lymphocytes (TILs) have emerged as effective biomarkers for predicting treatment response and prognosis in breast cancer. The work described here was aimed at designing a novel deep learning network to assess the levels of TILs in breast ultrasound images. METHODS We propose the Multi-Cascade Residual U-Shaped Network (MCRUNet), which incorporates a gray feature enhancement (GFE) module for image reconstruction and normalization to achieve data synergy. Additionally, multiple residual U-shaped (RSU) modules are cascaded as the backbone network to maximize the fusion of global and local features, with a focus on the tumor's location and surrounding regions. The development of MCRUNet is based on data from two hospitals and uses a publicly available ultrasound data set for transfer learning. RESULTS MCRUNet exhibits excellent performance in assessing TILs levels, achieving an area under the receiver operating characteristic curve of 0.8931, an accuracy of 85.71%, a sensitivity of 83.33%, a specificity of 88.64% and an F1 score of 86.54% in the test group. It outperforms six state-of-the-art networks in terms of performance. CONCLUSION The MCRUNet network based on breast ultrasound images of breast cancer patients holds promise for non-invasively predicting TILs levels and aiding personalized treatment decisions.
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Affiliation(s)
- Ruichao Wu
- School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Yingying Jia
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Nana Li
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Xiangyu Lu
- School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Zihuan Yao
- School of Information Science and Engineering, Lanzhou University, Lanzhou, China
| | - Yide Ma
- School of Information Science and Engineering, Lanzhou University, Lanzhou, China.
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China; Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China; Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
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Frankowska K, Zarobkiewicz M, Dąbrowska I, Bojarska-Junak A. Tumor infiltrating lymphocytes and radiological picture of the tumor. Med Oncol 2023; 40:176. [PMID: 37178270 PMCID: PMC10182948 DOI: 10.1007/s12032-023-02036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023]
Abstract
Tumor microenvironment (TME) is a complex entity that includes besides the tumor cells also a whole range of immune cells. Among various populations of immune cells infiltrating the tumor, tumor infiltrating lymphocytes (TILs) are a population of lymphocytes characterized by high reactivity against the tumor component. As, TILs play a key role in mediating responses to several types of therapy and significantly improve patient outcomes in some cancer types including for instance breast cancer and lung cancer, their assessment has become a good predictive tool in the evaluation of potential treatment efficacy. Currently, the evaluation of the density of TILs infiltration is performed by histopathological. However, recent studies have shed light on potential utility of several imaging methods, including ultrasonography, magnetic resonance imaging (MRI), positron emission tomography-computed tomography (PET-CT), and radiomics, in the assessment of TILs levels. The greatest attention concerning the utility of radiology methods is directed to breast and lung cancers, nevertheless imaging methods of TILs are constantly being developed also for other malignancies. Here, we focus on reviewing the radiological methods used to assess the level of TILs in different cancer types and on the extraction of the most favorable radiological features assessed by each method.
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Affiliation(s)
- Karolina Frankowska
- Department of Clinical Immunology, Medical University of Lublin, Lublin, Poland
| | - Michał Zarobkiewicz
- Department of Clinical Immunology, Medical University of Lublin, Lublin, Poland.
| | - Izabela Dąbrowska
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, Lublin, Poland
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Xue C, Zhou Q, Xi H, Zhou J. Radiomics: A review of current applications and possibilities in the assessment of tumor microenvironment. Diagn Interv Imaging 2023; 104:113-122. [PMID: 36283933 DOI: 10.1016/j.diii.2022.10.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 12/24/2022]
Abstract
With the recent success in the application of immunotherapy for treating various advanced cancers, the tumor microenvironment has rapidly become an important field of research. The tumor microenvironment is complex and its characteristics strongly influence disease biology and potentially responses to systemic therapy. Accurate preoperative assessment of tumor microenvironment is of great significance for the formulation of an immunotherapy strategy and evaluation of patient prognosis. As a research hotspot in medical image analysis technology, radiomics has been applied in the auxiliary diagnosis of the tumor microenvironment. This article reviews the current status of radiomics in the elective application on tumor microenvironment and discusses potential prospects.
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Affiliation(s)
- Caiqiang Xue
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Qing Zhou
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Huaze Xi
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China
| | - Junlin Zhou
- Department of Radiology, Lanzhou University Second Hospital, Chengguan District, Lanzhou, 730030, China; Second Clinical School, Lanzhou University, Lanzhou, 730030, China; Key Laboratory of Medical Imaging of Gansu Province, Lanzhou, 730030, China; Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial Intelligence, Lanzhou, 730030, China.
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Jia Y, Zhu Y, Li T, Song X, Duan Y, Yang D, Nie F. Evaluating Tumor-Infiltrating Lymphocytes in Breast Cancer: The Role of Conventional Ultrasound and Contrast-Enhanced Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:623-634. [PMID: 35866231 DOI: 10.1002/jum.16058] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVES Tumor-infiltrating lymphocytes (TILs) have emerged as an efficient biomarker predicting treatment response and prognosis of breast cancer (BC). This study aimed to evaluate the association between conventional ultrasound and contrast-enhanced ultrasound (CEUS) imaging features with TIL levels in invasive BC patients. METHODS We retrospectively included 267 women with invasive BC who had undergone conventional ultrasound and CEUS. Patients were divided into low (≤10%) and high (>10%) TIL groups. Conventional ultrasound and CEUS features were analyzed by two sonographers. The associations between the TIL levels and imaging features were evaluated. RESULTS Of the 267 patients, 122 with high TILs and 145 with low TIL levels. High TIL tumors were more likely to have a circumscribed margin, oval or round shape, and enhanced posterior echoes on ultrasonography (p < 0.05). In contrast, low TIL tumors were more likely to have an irregular shape, un-circumscribed, indistinct and spiculated margin (p < 0.05). In CEUS, high TIL tumors showed a more regular shape, clearer margin, more homogeneous enhancement and higher peak intensity (PI) value (p < 0.05). Logistic analysis indicated that shape, posterior features, PI, and enhanced homogeneity were independent predictors for high TIL tumors. The model combined the four independent predictors have a moderate performance in predicting high TIL tumors with AUC 0.79, sensitivity 0.72, and specificity 0.78. CONCLUSIONS Conventional ultrasound and CEUS features were associated with TIL levels in invasive BC. Consequently, the results suggested that preoperative conventional ultrasound and CEUS may be a useful noninvasive imaging biomarker for individualized treatment decisions.
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Affiliation(s)
- Yingying Jia
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Department of Ultrasound, People's Hospital of Ningxia Hui Nationality Autonomous Region, Yinchuan, Ningxia, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
- Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Yangyang Zhu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
- Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Ting Li
- Department of Ultrasound, People's Hospital of Ningxia Hui Nationality Autonomous Region, Yinchuan, Ningxia, China
| | - XueWen Song
- Pathology Department, Lanzhou University Second Hospital, Lanzhou, China
| | - Ying Duan
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
- Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Dan Yang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
- Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
- Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China
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10
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Jia Y, Wu R, Lu X, Duan Y, Zhu Y, Ma Y, Nie F. Deep Learning with Transformer or Convolutional Neural Network in the Assessment of Tumor-Infiltrating Lymphocytes (TILs) in Breast Cancer Based on US Images: A Dual-Center Retrospective Study. Cancers (Basel) 2023; 15:cancers15030838. [PMID: 36765796 PMCID: PMC9913836 DOI: 10.3390/cancers15030838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/20/2023] [Accepted: 01/27/2023] [Indexed: 02/01/2023] Open
Abstract
This study aimed to explore the feasibility of using a deep-learning (DL) approach to predict TIL levels in breast cancer (BC) from ultrasound (US) images. A total of 494 breast cancer patients with pathologically confirmed invasive BC from two hospitals were retrospectively enrolled. Of these, 396 patients from hospital 1 were divided into the training cohort (n = 298) and internal validation (IV) cohort (n = 98). Patients from hospital 2 (n = 98) were in the external validation (EV) cohort. TIL levels were confirmed by pathological results. Five different DL models were trained for predicting TIL levels in BC using US images from the training cohort and validated on the IV and EV cohorts. The overall best-performing DL model, the attention-based DenseNet121, achieved an AUC of 0.873, an accuracy of 79.5%, a sensitivity of 90.7%, a specificity of 65.9%, and an F1 score of 0.830 in the EV cohort. In addition, the stratified analysis showed that the DL models had good discrimination performance of TIL levels in each of the molecular subgroups. The DL models based on US images of BC patients hold promise for non-invasively predicting TIL levels and helping with individualized treatment decision-making.
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Affiliation(s)
- Yingying Jia
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China
- Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Ultrasonography, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China
| | - Ruichao Wu
- School of Information Science and Engineering, Lanzhou University, No. 222 South Tianshui Road, Lanzhou 730030, China
| | - Xiangyu Lu
- School of Information Science and Engineering, Lanzhou University, No. 222 South Tianshui Road, Lanzhou 730030, China
| | - Ying Duan
- Department of Ultrasound, Gansu Provincial Cancer Hospital, West Lake East Street No. 2, Qilihe District, Lanzhou 730030, China
| | - Yangyang Zhu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China
- Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Ultrasonography, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China
| | - Yide Ma
- School of Information Science and Engineering, Lanzhou University, No. 222 South Tianshui Road, Lanzhou 730030, China
- Correspondence: (Y.M.); (F.N.)
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China
- Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Ultrasonography, Cuiyingmen No. 82, Chengguan District, Lanzhou 730030, China
- Correspondence: (Y.M.); (F.N.)
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Lin G, Wang X, Ye H, Cao W. Radiomic Models Predict Tumor Microenvironment Using Artificial Intelligence-the Novel Biomarkers in Breast Cancer Immune Microenvironment. Technol Cancer Res Treat 2023; 22:15330338231218227. [PMID: 38111330 PMCID: PMC10734346 DOI: 10.1177/15330338231218227] [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: 09/12/2023] [Revised: 10/22/2023] [Accepted: 11/16/2023] [Indexed: 12/20/2023] Open
Abstract
Breast cancer is the most common malignancy in women, and some subtypes are associated with a poor prognosis with a lack of efficacious therapy. Moreover, immunotherapy and the use of other novel antibody‒drug conjugates have been rapidly incorporated into the standard management of advanced breast cancer. To extract more benefit from these therapies, clarifying and monitoring the tumor microenvironment (TME) status is critical, but this is difficult to accomplish based on conventional approaches. Radiomics is a method wherein radiological image features are comprehensively collected and assessed to build connections with disease diagnosis, prognosis, therapy efficacy, the TME, etc In recent years, studies focused on predicting the TME using radiomics have increasingly emerged, most of which demonstrate meaningful results and show better capability than conventional methods in some aspects. Beyond predicting tumor-infiltrating lymphocytes, immunophenotypes, cytokines, infiltrating inflammatory factors, and other stromal components, radiomic models have the potential to provide a completely new approach to deciphering the TME and facilitating tumor management by physicians.
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Affiliation(s)
- Guang Lin
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Xiaojia Wang
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Hunan Ye
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Wenming Cao
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
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Kitajima K, Higuchi T, Fujimoto Y, Ishikawa E, Yokoyama H, Komoto H, Inao Y, Yamakado K, Miyoshi Y. Relationship between FDG-PET and the immune microenvironment in breast cancer. Eur J Radiol 2023; 158:110661. [PMID: 36542934 DOI: 10.1016/j.ejrad.2022.110661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate the relationship between fluorodeoxyglucose (FDG) uptake (maximum standardised uptake value [SUVmax]) and immune markers (tumour-infiltrating lymphocytes [TILs] and neutrophil-to-lymphocyte ratio [NLR]) and evaluate the potential prognostic value of any correlations. METHODS Data from 502 patients with breast cancer, including 346 oestrogen receptor (ER)-positive / human epidermal growth factor receptor 2 (HER2)-negative, 88 HER2-positive, and 68 triple-negative cases, who had undergone surgery were reviewed. Relationships between the clinicopathological factors, SUVmax, TILs, NLR, recurrence-free survival (RFS), and overall survival of all patients and each subtype were evaluated using a Cox proportional hazards model and log-rank test. A sub-analysis of patients divided into low and high TIL groups was also undertaken. RESULTS High SUVmax was significantly related to high TILs (p < 0.0001). In low TIL (TILs1) group, patients with high SUVmax (≥3.585) had a significantly shorter RFS than those with low SUVmax (<3.585; p < 0.0001). In high TIL (TILs2,3) group, patients with high SUVmax had a shorter RFS than those with low SUVmax without a significant difference (p = 0.35). Multivariate analysis of 502 patients showed high SUVmax, high T status, and nodal metastasis were independent negative predictors of RFS. In 317 TILs-low patients, high SUVmax, high T status, nodal metastasis, and ER-positivity were independent predictors of RFS. In 185 TILs-high patients, nodal metastasis was an independent predictor of RFS. In ER-positive/HER2-negative and HER2-positive subtypes, SUVmax was a significant predictive parameter in the TILs-low but not TILs-high groups. CONCLUSION FDG uptake may be predictive of immunological features and aggressive features in breast cancer patients.
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Affiliation(s)
| | - Tomoko Higuchi
- Department of Surgery, Division of Breast and Endocrine Surgery, Hyogo College of Medicine, Hyogo, Japan.
| | - Yukie Fujimoto
- Department of Surgery, Division of Breast and Endocrine Surgery, Hyogo College of Medicine, Hyogo, Japan.
| | - Eri Ishikawa
- Department of Surgical Pathology, Hyogo College of Medicine, Hyogo, Japan.
| | | | - Hisashi Komoto
- Department of Radiology, Hyogo College of Medicine, Hyogo, Japan.
| | - Yoshie Inao
- Department of Radiology, Hyogo College of Medicine, Hyogo, Japan.
| | | | - Yasuo Miyoshi
- Department of Surgery, Division of Breast and Endocrine Surgery, Hyogo College of Medicine, Hyogo, Japan.
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Li W, Lv L, Ruan M, Xu J, Zhu W, Li Q, Jiang X, Zheng L, Zhu W. Qin Huang formula enhances the effect of Adriamycin in B-cell lymphoma via increasing tumor infiltrating lymphocytes by targeting toll-like receptor signaling pathway. BMC Complement Med Ther 2022; 22:185. [PMID: 35818037 PMCID: PMC9272877 DOI: 10.1186/s12906-022-03660-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/29/2022] [Indexed: 12/05/2022] Open
Abstract
Background As an original traditional Chinese medicinal formula, Qin Huang formula (QHF) is used as adjuvant therapy for treating lymphoma in our hospital and has proven efficacy when combined with chemotherapy. However, the underlying mechanisms of QHF have not been elucidated. Methods A network pharmacological-based analysis method was used to screen the active components and predict the potential mechanisms of QHF in treating B cell lymphoma. Then, a murine model was built to verify the antitumor effect of QHF combined with Adriamycin (ADM) in vivo. Finally, IHC, ELISA, 18F-FDG PET-CT scan, and western blot were processed to reveal the intriguing mechanism of QHF in treating B cell lymphoma. Results The systemic pharmacological study revealed that QHF took effect following a multiple-target and multiple-pathway pattern in the human body. In vivo study showed that combination therapy with QHF and ADM potently inhibited the growth of B cell lymphoma in a syngeneic murine model, and significantly increased the proportion of tumor infiltrating CD4+ and CD8+ T cells in the tumor microenvironment (TME). Furthermore, the level of CXCL10 and IL-6 was significantly increased in the combination group. Finally, the western blot exhibited that the level of TLR2 and p38 MAPK increased in the combination therapy group. Conclusion QHF in combination of ADM enhances the antitumor effect of ADM via modulating tumor immune microenvironment and can be a combination therapeutic strategy for B cell lymphoma patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12906-022-03660-8.
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Cohen IJ, Pareja F, Socci ND, Shen R, Doane AS, Schwartz J, Khanin R, Morris EA, Sutton EJ, Blasberg RG. Increased tumor glycolysis is associated with decreased immune infiltration across human solid tumors. Front Immunol 2022; 13:880959. [PMID: 36505421 PMCID: PMC9731115 DOI: 10.3389/fimmu.2022.880959] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 09/20/2022] [Indexed: 11/25/2022] Open
Abstract
Response to immunotherapy across multiple cancer types is approximately 25%, with some tumor types showing increased response rates compared to others (i.e. response rates in melanoma and non-small cell lung cancer (NSCLC) are typically 30-60%). Patients whose tumors are resistant to immunotherapy often lack high levels of pre-existing inflammation in the tumor microenvironment. Increased tumor glycolysis, acting through glucose deprivation and lactic acid accumulation, has been shown to have pleiotropic immune suppressive effects using in-vitro and in-vivo models of disease. To determine whether the immune suppressive effect of tumor glycolysis is observed across human solid tumors, we analyzed glycolytic and immune gene expression patterns in multiple solid malignancies. We found that increased expression of a glycolytic signature was associated with decreased immune infiltration and a more aggressive disease across multiple tumor types. Radiologic and pathologic analysis of untreated estrogen receptor (ER)-negative breast cancers corroborated these observations, and demonstrated that protein expression of glycolytic enzymes correlates positively with glucose uptake and negatively with infiltration of CD3+ and CD8+ lymphocytes. This study reveals an inverse relationship between tumor glycolysis and immune infiltration in a large cohort of multiple solid tumor types.
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Affiliation(s)
- Ivan J. Cohen
- Gerstner Sloan Kettering Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States,*Correspondence: Ivan J. Cohen,
| | - Fresia Pareja
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Nicholas D. Socci
- Bioinformatics Core, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ronglai Shen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ashley S. Doane
- Molecular Pharmacology and Chemistry Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jazmin Schwartz
- Computational Biology and Medicine Tri-Institutional PhD Program, Weill Cornell Medicine, New York, NY, United States
| | - Raya Khanin
- Bioinformatics Core, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Elizabeth A. Morris
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Elizabeth J. Sutton
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ronald G. Blasberg
- Gerstner Sloan Kettering Graduate School of Biomedical Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, United States,Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, United States,Molecular Pharmacology and Chemistry Program, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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15
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Choi J, Sarker A, Choi H, Lee DS, Im HJ. Prognostic impact of an integrative analysis of [ 18F]FDG PET parameters and infiltrating immune cell scores in lung adenocarcinoma. EJNMMI Res 2022; 12:38. [PMID: 35759068 PMCID: PMC9237200 DOI: 10.1186/s13550-022-00908-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 06/15/2022] [Indexed: 09/28/2023] Open
Abstract
Background High levels of 18F-fluorodeoxyglucose (18F-FDG) tumor uptake are associated with worse prognosis in patients with non-small cell lung cancer (NSCLC). Meanwhile, high levels of immune cell infiltration in primary tumor have been linked to better prognosis in NSCLC. We conducted this study for precisely stratified prognosis of the lung adenocarcinoma patients using the integration of 18F-FDG positron emission tomography (PET) parameters and infiltrating immune cell scores as assessed by a genomic analysis. Results Using an RNA sequencing dataset, the patients were divided into three subtype groups. Additionally, 24 different immune cell scores and cytolytic scores (CYT) were obtained. In 18F-FDG PET scans, PET parameters of the primary tumors were obtained. An ANOVA test, a Chi-square test and a correlation analysis were also conducted. A Kaplan–Meier survival analysis with the log-rank test and multivariable Cox regression test was performed to evaluate prognostic values of the parameters. The terminal respiratory unit (TRU) group demonstrated lower 18F-FDG PET parameters, more females, and lower stages than the other groups. Meanwhile, the proximal inflammatory (PI) group showed a significantly higher CYT score compared to the other groups (P = .001). Also, CYT showed a positive correlation with tumor-to-liver maximum standardized uptake value ratio (TLR) in the PI group (P = .027). A high TLR (P = .01) score of 18F-FDG PET parameters and a high T follicular helper cell (TFH) score (P = .005) of immune cell scores were associated with prognosis with opposite tendencies. Furthermore, TLR and TFH were predictive of overall survival even after adjusting for clinicopathologic features and others (P = .024 and .047). Conclusions A high TLR score was found to be associated with worse prognosis, while high CD8 T cell and TFH scores predicted better prognosis in lung adenocarcinoma. Furthermore, TLR and TFH can be used to predict prognosis independently in patients with lung adenocarcinoma.
Supplementary Information The online version contains supplementary material available at 10.1186/s13550-022-00908-9.
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Affiliation(s)
- Jinyeong Choi
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, 08826, Republic of Korea
| | - Azmal Sarker
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hongyoon Choi
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyung-Jun Im
- Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, 08826, Republic of Korea. .,Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, 08826, Republic of Korea. .,Cancer Research Institute, Seoul National University, 03080, Seoul, Republic of Korea. .,Research Institute for Convergence Science, Seoul National University, Seoul, 08826, Republic of Korea.
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16
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Miyazaki K, Morine Y, Yamada S, Saito Y, Tokuda K, Okikawa S, Yamashita S, Oya T, Ikemoto T, Imura S, Hu H, Morioka H, Tsuneyama K, Shimada M. Stromal tumor-infiltrating lymphocytes level as a prognostic factor for resected intrahepatic cholangiocarcinoma and its prediction by apparent diffusion coefficient. Int J Clin Oncol 2021; 26:2265-2274. [PMID: 34596803 DOI: 10.1007/s10147-021-02026-3] [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: 05/09/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Tumor-infiltrating lymphocytes (TILs) are a prognostic factor or an indicator of chemotherapy response for various malignancies. The aim of this study was to investigate the prognostic impact of TILs in resected intrahepatic cholangiocarcinoma (IHCC). We also investigated the usefulness of the apparent diffusion coefficient (ADC) in diffusion-weighted magnetic resonance imaging (DW-MRI) to predict TILs. METHODS We enrolled 23 patients with IHCC who underwent initial hepatic resection in Tokushima University Hospital from 2006 to 2017. We evaluated stromal TILs in the tumor marginal area and central area in surgical specimens. Patients were divided into low vs high stromal TILs groups. We analyzed the patients' clinicopathological factors, including prognosis, according to the degree of stromal TILs. We also analyzed the correlation between stromal TILs and the minimum ADC value. RESULTS Stromal TILs in the marginal area reflected overall survival more accurately than that in the central area. Additionally, marginal low TILs was significantly associated with lymph node metastasis and portal vein invasion. Both overall- and disease-free survival rates in the marginal low TILs group were significantly worse than those in the marginal high TILs group (P < 0.05). In the multivariate analysis, marginal low TILs were an independent prognostic factor for both overall- and disease-free survival (P < 0.05), and marginal low TILs were significantly associated with lower minimum ADC values (P < 0.02). CONCLUSIONS Stromal TILs, especially in the marginal area, might demonstrate prognostic impact in patients with IHCC. Moreover, the ADC values from MRI may predict TILs in IHCC tumor tissue.
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Affiliation(s)
- Katsuki Miyazaki
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Yuji Morine
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Shinichiro Yamada
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Yu Saito
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Kazunori Tokuda
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Shohei Okikawa
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Shoko Yamashita
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.,Department of Pathology and Laboratory Medicine, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Takeshi Oya
- Department of Molecular Pathology, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Tetsuya Ikemoto
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Satoru Imura
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Haun Hu
- Department of Public Health, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Hisayoshi Morioka
- Department of Public Health, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Koichi Tsuneyama
- Department of Pathology and Laboratory Medicine, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Mitsuo Shimada
- Department of Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.
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Bian T, Wu Z, Lin Q, Mao Y, Wang H, Chen J, Chen Q, Fu G, Cui C, Su X. Evaluating Tumor-Infiltrating Lymphocytes in Breast Cancer Using Preoperative MRI-Based Radiomics. J Magn Reson Imaging 2021; 55:772-784. [PMID: 34453461 DOI: 10.1002/jmri.27910] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Evaluating tumor-infiltrating lymphocytes (TILs) in patients with breast cancer using radiomics has been rarely explored. PURPOSE To establish a radiomics nomogram based on dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) for preoperatively evaluating TIL level. STUDY TYPE Retrospective. POPULATION A total of 154 patients with breast cancer were divided into a training cohort (N = 87) and a test cohort (N = 67), who were further divided into low TIL (<50%) and high TIL (≥50%) subgroups according to the histopathological results. FIELD STRENGTH/SEQUENCE 3.0 T; axial T2-weighted imaging (fast spin echo), diffusion-weighted imaging (spin echo-echo planar imaging), and the volume imaging for breast assessment DCE sequence (gradient recalled echo). ASSESSMENT A radiomics signature was developed from the training dataset and independent risk factors were selected by multivariate logistic regression to build a clinical model. A nomogram model was built by combining radiomics score and risk factors. The performance of the nomogram was assessed using calibration curves and decision curves. The area under the receiver operating characteristic (ROC) curve, accuracy, sensitivity, and specificity were calculated. STATISTICAL TESTS The least absolute shrinkage and selection operator, univariate and multivariate logistic regression analysis, t-tests and chi-squared tests or Fisher's exact test, Hosmer-Lemeshow test, ROC analysis, and decision curve analysis were conducted. P < 0.05 was considered statistically significant. RESULTS The radiomics signature and nomogram model exhibited better calibration and validation performance in the training (radiomics: area under the curve [AUC] 0.86; nomogram: AUC 0.88) and test (radiomics: AUC 0.83; nomogram: AUC 0.84) datasets compared with clinical model (training: AUC 0.76; test: AUC 0.72). The decision curve demonstrated that the nomogram model exhibited better performance than the clinical model, with a threshold probability between 0.15 and 0.9. DATA CONCLUSION The nomogram model based on preoperative MRI exhibited an excellent ability for the noninvasive evaluation of TILs in breast cancer. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Tiantian Bian
- Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zengjie Wu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qing Lin
- Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Mao
- Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haibo Wang
- Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingjing Chen
- Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qianqian Chen
- GE Healthcare, Precision Health Institution, Shanghai, China
| | - Guangming Fu
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chunxiao Cui
- Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaohui Su
- Breast Disease Center, The Affiliated Hospital of Qingdao University, Qingdao, China
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Human Epidermal Growth Factor Receptor Type 2-Positive Breast Cancer: Association of MRI and Clinicopathologic Features With Tumor-Infiltrating Lymphocytes. AJR Am J Roentgenol 2021; 218:258-269. [PMID: 34431365 DOI: 10.2214/ajr.21.26400] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: Tumor-infiltrating lymphocytes (TILs) are associated with therapeutic outcomes and prognosis in patients with human epidermal growth factor receptor type 2-positive (HER2+) breast cancer. Identification of TIL levels is clinically relevant. Objective: To explore associations of clinicopathologic and MRI features with TIL levels in patients with HER2+ breast cancer. Methods: A total of 212 consecutive women (mean age, 54 years) diagnosed with HER2+ breast cancer between January 2017 and December 2019 were included in this retrospective study. Patients were divided into low (<10%) and high (≥10%) TIL groups. Three breast radiologists independently reviewed images; interreader agreement was assessed, and the first readers' findings were used for further analysis. Associations of clinicopathologic and MRI features with TIL levels were evaluated using multivariable logistic regression analysis. Subanalysis of TIL levels by hormone receptor (HR) status was also performed. Results: A total of 115 (54.2%) patients had low, and 97 (45.8%) had high, TIL levels. High TIL level was associated (all p<.05) with histologic grade 3 (odds ratio [OR]=3.98; frequency of 78.4% vs 52.2% in high vs low TIL groups, respectively), high tumor cellularity (OR=4.59; median cellularity of 60% vs 50%), lower frequency of associated ductal carcinoma in situ (OR=0.16; frequency of 86.6% vs 94.8%), and higher frequency of peritumoral edema on T2-weighted images (OR=2.83; 71.1% vs 50.4%). In subgroup analysis by HR status, histologic grade 3 (OR=5.03, p=.002) was a significant independent predictor of high TIL in the HR+/HER2+ group, while high tumor cellularity (OR=9.06, p=.002), peritumoral edema (OR=5.23, p=.03), and low ADC (OR=11.69, p=.047) were independent predictors of high TIL in the HR-/HER2+ group. Interreader agreement for peritumoral edema was moderate among the three radiologists (к, range 0.432-0.539). Conclusion: Peritumoral edema on MRI and histopathologic feature of tumor aggressiveness help predict high TIL levels in patients with HER2+ breast cancer. Clinical Impact: Pretreatment MRI features may serve as a useful tool for assessing TIL levels in patients with HER2+ breast cancer, helping to classify patients with variable clinical outcomes related to immune activity and to guide selection among neoadjuvant chemotherapy (NAC) or HER2-targeted therapy or immunotherapy.
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Tang WJ, Kong QC, Cheng ZX, Liang YS, Jin Z, Chen LX, Hu WK, Liang YY, Wei XH, Guo Y, Jiang XQ. Performance of radiomics models for tumour-infiltrating lymphocyte (TIL) prediction in breast cancer: the role of the dynamic contrast-enhanced (DCE) MRI phase. Eur Radiol 2021; 32:864-875. [PMID: 34430998 DOI: 10.1007/s00330-021-08173-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/20/2021] [Accepted: 06/25/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To systematically investigate the effect of imaging features at different DCE-MRI phases to optimise a radiomics model based on DCE-MRI for the prediction of tumour-infiltrating lymphocyte (TIL) levels in breast cancer. MATERIALS AND METHODS This study retrospectively collected 133 patients with pathologically proven breast cancer, including 73 patients with low TIL levels and 60 patients with high TIL levels. The volumes of breast cancer lesions were manually delineated on T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and each phase of DCE-MRI, followed by 6250 quantitative feature extractions. The least absolute shrinkage and selection operator (LASSO) method was used to select predictive feature sets for the classifiers. Four models were developed for predicting TILs: (1) single enhanced phase radiomics models; (2) fusion enhanced multi-phase radiomics models; (3) fusion multi-sequence radiomics models; and (4) a combined radiomics-based clinical model. RESULTS Image features extracted from the delayed phase MRI, especially DCE_Phase 6 (DCE_P6), demonstrated dominant predictive performances over features from other phases. The fusion multi-sequence radiomics model and combined radiomics-based clinical model achieved the highest predictive performances with areas under the curve (AUCs) of 0.934 and 0.950, respectively; however, the differences were not statistically significant. CONCLUSION The DCE-MRI radiomics model, especially image features extracted from the delayed phases, can help improve the performance in predicting TILs. The radiomics nomogram is effective in predicting TILs in breast cancer. KEY POINTS • Radiomics features extracted from DCE-MRI, especially delayed phase images, help predict TIL levels in breast cancer. • We developed a nomogram based on MRI to predict TILs in breast cancer that achieved the highest AUC of 0.950.
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Affiliation(s)
- Wen-Jie Tang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China
| | - Qing-Cong Kong
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510630, Guangdong, China
| | - Zi-Xuan Cheng
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China
| | - Yun-Shi Liang
- Department of Pathology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China
| | - Zhe Jin
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China
| | - Lei-Xin Chen
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China
| | - Wen-Ke Hu
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China
| | - Ying-Ying Liang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China
| | - Xin-Hua Wei
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China
| | - Yuan Guo
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China.
| | - Xin-Qing Jiang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, 510180, Guangdong, China.
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PET/MRI for Staging the Axilla in Breast Cancer: Current Evidence and the Rationale for SNB vs. PET/MRI Trials. Cancers (Basel) 2021; 13:cancers13143571. [PMID: 34298781 PMCID: PMC8303241 DOI: 10.3390/cancers13143571] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 07/05/2021] [Accepted: 07/12/2021] [Indexed: 01/03/2023] Open
Abstract
Simple Summary PET/MRI is a relatively new, hybrid imaging tool that allows practitioners to obtain both a local and systemic staging in breast cancer patients in a single exam. To date, the available evidence is not sufficient to determine the role of PET/MRI in breast cancer management. The aims of this paper are to provide an overview of the current literature on PET/MRI in breast cancer, and to illustrate two ongoing trials aimed at defining the eventual role of PET/MRI in axillary staging in two different settings: patients with early breast cancer and patients with positive axillary nodes that are candidates for primary systemic therapy. In both cases, findings from PET/MRI will be compared with the final pathology and could be helpful to better tailor axillary surgery in the future. Abstract Axillary surgery in breast cancer (BC) is no longer a therapeutic procedure but has become a purely staging procedure. The progressive improvement in imaging techniques has paved the way to the hypothesis that prognostic information on nodal status deriving from surgery could be obtained with an accurate diagnostic exam. Positron emission tomography/magnetic resonance imaging (PET/MRI) is a relatively new imaging tool and its role in breast cancer patients is still under investigation. We reviewed the available literature on PET/MRI in BC patients. This overview showed that PET/MRI yields a high diagnostic performance for the primary tumor and distant lesions of liver, brain and bone. In particular, the results of PET/MRI in staging the axilla are promising. This provided the rationale for two prospective comparative trials between axillary surgery and PET/MRI that could lead to a further de-escalation of surgical treatment of BC. • SNB vs. PET/MRI 1 trial compares PET/MRI and axillary surgery in staging the axilla of BC patients undergoing primary systemic therapy (PST). • SNB vs. PET/MRI 2 trial compares PET/MRI and sentinel node biopsy (SNB) in staging the axilla of early BC patients who are candidates for upfront surgery. Finally, these ongoing studies will help clarify the role of PET/MRI in BC and establish whether it represents a useful diagnostic tool that could guide, or ideally replace, axillary surgery in the future.
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An YS, Kim SH, Roh TH, Park SH, Kim TG, Kim JH. Correlation Between 18F-FDG Uptake and Immune Cell Infiltration in Metastatic Brain Lesions. Front Oncol 2021; 11:618705. [PMID: 34249674 PMCID: PMC8266210 DOI: 10.3389/fonc.2021.618705] [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: 10/18/2020] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background The purpose of this study was to investigate the correlation between 18F-fluorodeoxyglucose (FDG) uptake and infiltrating immune cells in metastatic brain lesions. Methods This retrospective study included 34 patients with metastatic brain lesions who underwent brain 18F-FDG positron emission tomography (PET)/computed tomography (CT) followed by surgery. 18F-FDG uptake ratio was calculated by dividing the standardized uptake value (SUV) of the metastatic brain lesion by the contralateral normal white matter uptake value. We investigated the clinicopathological characteristics of the patients and analyzed the correlation between 18F-FDG uptake and infiltration of various immune cells. In addition, we evaluated immune-expression levels of glucose transporter 1 (GLUT1), hexokinase 2 (HK2), and Ki-67 in metastatic brain lesions. Results The degree of 18F-FDG uptake of metastatic brain lesions was not significantly correlated with clinical parameters. There was no significant relationship between the 18F-FDG uptake and degree of immune cell infiltration in brain metastasis. Furthermore, other markers, such as GLUT1, HK2, and Ki-67, were not correlated with degree of 18F-FDG uptake. In metastatic brain lesions that originated from breast cancer, a higher degree of 18F-FDG uptake was observed in those with high expression of CD68. Conclusions In metastatic brain lesions, the degree of 18F-FDG uptake was not significantly associated with infiltration of immune cells. The 18F-FDG uptake of metastatic brain lesions from breast cancer, however, might be associated with macrophage activity.
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Affiliation(s)
- Young-Sil An
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, South Korea
| | - Se-Hyuk Kim
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, South Korea
| | - Tae Hoon Roh
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, South Korea
| | - So Hyun Park
- Department of Pathology, Ajou University School of Medicine, Suwon, South Korea
| | - Tae-Gyu Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, South Korea
| | - Jang-Hee Kim
- Department of Pathology, Ajou University School of Medicine, Suwon, South Korea
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Relationship of the standard uptake value of 18F-FDG-PET-CT with tumor-infiltrating lymphocytes in breast tumors measuring ≥ 1 cm. Sci Rep 2021; 11:12046. [PMID: 34103577 PMCID: PMC8187353 DOI: 10.1038/s41598-021-91404-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/26/2021] [Indexed: 01/05/2023] Open
Abstract
Evidence suggests that tumor cells and tumor-infiltrating lymphocytes (TILs) compete for glucose in the tumor microenvironment and that tumor metabolic parameters correlate with localized immune markers in several solid tumors. We investigated the relationship of the standardized uptake value (SUV) of 18F-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG-PET-CT) with stromal TIL levels in breast cancer. We included 202 patients who underwent preoperative 18F-FDG-PET-CT and had a tumor measuring ≥ 1 cm. Maximum SUV (SUVmax) was determined using 18F-FDG-PET-CT. Multiple logistic regression was used to identify factors related to high TIL levels (≥ 40%). All tumors were treatment naïve. A significant and weak correlation existed between continuous SUVmax and continuous TIL levels (p = 0.002, R = 0.215). Tumors with high SUVmax (≥ 4) had higher mean TIL levels than those with low SUVmax (< 4). In multivariable analysis, continuous SUVmax was an independent factor associated with high TIL levels; each 1-unit increment in SUVmax corresponded to an odds ratio of 1.14 (95% confidence interval: 1.01–1.29) for high TIL levels. Our study implies that SUV is associated with TILs in breast cancer and provides clinical evidence that elevated glucose uptake by breast tumors can predict the immune system-activated tumor micromilieu.
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Tang WJ, Jin Z, Zhang YL, Liang YS, Cheng ZX, Chen LX, Liang YY, Wei XH, Kong QC, Guo Y, Jiang XQ. Whole-Lesion Histogram Analysis of the Apparent Diffusion Coefficient as a Quantitative Imaging Biomarker for Assessing the Level of Tumor-Infiltrating Lymphocytes: Value in Molecular Subtypes of Breast Cancer. Front Oncol 2021; 10:611571. [PMID: 33489920 PMCID: PMC7820903 DOI: 10.3389/fonc.2020.611571] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022] Open
Abstract
Purpose To assess whether apparent diffusion coefficient (ADC) metrics can be used to assess tumor-infiltrating lymphocyte (TIL) levels in breast cancer, particularly in the molecular subtypes of breast cancer. Methods In total, 114 patients with breast cancer met the inclusion criteria (mean age: 52 years; range: 29–85 years) and underwent multi-parametric breast magnetic resonance imaging (MRI). The patients were imaged by diffusion-weighted (DW)-MRI (1.5 T) using a single-shot spin-echo echo-planar imaging sequence. Two readers independently drew a region of interest (ROI) on the ADC maps of the whole tumor. The mean ADC and histogram parameters (10th, 25th, 50th, 75th, and 90th percentiles of ADC, skewness, entropy, and kurtosis) were used as features to analyze associations with the TIL levels in breast cancer. Additionally, the correlation between the ADC values and Ki-67 expression were analyzed. Continuous variables were compared with Student’s t-test or Mann-Whitney U test if the variables were not normally distributed. Categorical variables were compared using Pearson’s chi-square test or Fisher’s exact test. Associations between TIL levels and imaging features were evaluated by the Mann-Whitney U and Kruskal-Wallis tests. Results A statistically significant difference existed in the 10th and 25th percentile ADC values between the low and high TIL groups in breast cancer (P=0.012 and 0.027). For the luminal subtype of breast cancer, the 10th percentile ADC value was significantly lower in the low TIL group (P=0.041); for the non-luminal subtype of breast cancer, the kurtosis was significantly lower in the low TIL group (P=0.023). The Ki-67 index showed statistical significance for evaluating the TIL levels in breast cancer (P=0.007). Additionally, the skewness was significantly higher for samples with high Ki-67 levels in breast cancer (P=0.029). Conclusions Our findings suggest that whole-lesion ADC histogram parameters can be used as surrogate biomarkers to evaluate TIL levels in molecular subtypes of breast cancer.
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Affiliation(s)
- Wen-Jie Tang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Zhe Jin
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yan-Ling Zhang
- Department of Ultrasound, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yun-Shi Liang
- Department of Pathology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Zi-Xuan Cheng
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Lei-Xin Chen
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Ying-Ying Liang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xin-Hua Wei
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Qing-Cong Kong
- Department of Radiology, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuan Guo
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xin-Qing Jiang
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
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