The Role of PET/CT Molecular Imaging in the Diagnosis of Recurrence and Surveillance of Patients Treated for Non-Small Cell Lung Cancer

Imaging glucose metabolism to reveal tumor progression

Purpose: To analyze and review the progress of glucose metabolism-based molecular imaging in detecting tumors to guide clinicians for new management strategies. Summary: When metabolic abnormalities occur, termed the Warburg effect, it simultaneously enables excessive cell proliferation and inhibits cell apoptosis. Molecular imaging technology combines molecular biology and cell probe technology to visualize, characterize, and quantify processes at cellular and subcellular levels in vivo. Modern instruments, including molecular biochemistry, data processing, nanotechnology, and image processing, use molecular probes to perform real-time, non-invasive imaging of molecular and cellular events in living organisms. Conclusion: Molecular imaging is a non-invasive method for live detection, dynamic observation, and quantitative assessment of tumor glucose metabolism. It enables in-depth examination of the connection between the tumor microenvironment and tumor growth, providing a reliable assessment technique for scientific and clinical research. This new technique will facilitate the translation of fundamental research into clinical practice.

Impact of Follow-up 18F-FDG PET on the Management in Patients With Lung Cancer: A Meta-analysis

PURPOSE

The incidence of lung cancer has increased steadily. We meta-analyzed to assess the impact of 18F-FDG PET on the management of lung cancer to detect recurrence/metastasis.

MATERIALS AND METHODS

We performed systematic searches of Medline and Embase databases for English-language publications. All published studies regarding the impact of PET on the management of patients with lung cancer in detection of recurrence/metastasis were searched. The proportion of management change (%) defined as the percentage of patients who changed management after FDG PET to patients who had FDG PET was calculated. The data from each study were analyzed using MedCalc Statistical Software version 14.12.0 (MedCalc Software, Ostend, Belgium).

RESULTS

Eight studies including 523 patients were eligible for inclusion in the study. The impact of 18F-FDG PET for the purpose of detecting recurrence/metastasis in patients with lung cancer was evaluated using management change rates, which were ranged from 28.6% to 79.2% with a pooled effect of 61.4% (95% confidence interval, 49.5%-72.7%; I2 = 85.7%). In a subgroup analysis, impact of 18F-FDG PET was evaluated in studies of patients with non-small cell lung cancer with indication of abnormal findings of conventional imaging, elevated tumor markers, and clinical symptoms with the pooled rate of management change of 62.2% (95% confidence interval, 44.2%-78.5%; I2 = 88.0%).

CONCLUSIONS

We have highlighted that 18F-FDG PET has a major impact on the management of patients with recurrent lung cancer. These findings suggest that 18F-FDG PET should be performed in patients with lung cancer, especially in cases involving equivocal or suspicious recurrence/metastasis on conventional imaging, elevated tumor markers, or clinical symptoms during follow-up.

SP70-Targeted Imaging for the Early Detection of Lung Adenocarcinoma

NJ001 is a monoclonal antibody that can specifically recognize the SP70 antigen on lung adenocarcinoma cells. The goal of this study was to explore its utility in targeted imaging. Subcutaneous xenograft and orthotopic lung tumor implantation BALB/c mouse models were established. Near-infrared fluorescent CF750-labeled NJ001 was injected into two tumor mouse models. Mice that received orthotopic lung tumor implantation were also injected with NJ001-conjugated nanomagnetic beads intravenously, and then underwent micro-CT scanning. Meanwhile, mice with lung tumor were intravenously injected with normal saline and bare nanomagnetic beads as a control. Fluorescence could be monitored in the mice detected by anti-SP70 fluorescence imaging, which was consistent with tumor burden. Signal intensities detected with SP70-targeted micro-CT scans were greater than those in control mice. More importantly, orthotopic tumor lesions could be found on the fourth week with SP70-targeted imaging, which was 2 weeks earlier than detection in the control. Our results suggest that SP70 is a promising target for molecular imaging, and molecularly targeted imaging with an NJ001-labeled probe could be applied for the early detection of lung adenocarcinoma.

18F-FDG PET/CT of Lung Adenocarcinoma With Ovarian Metastases

Patient was a 52-year-old woman with medical history of lung adenocarcinoma operated in 2009 (stage I, T2 N0 M0), showing increasing levels of tumor markers and a doubtful retrocrural adenopathy by means of CT scan with intravenous contrast. An F-FDG PET/CT was performed, which showed 2 hypermetabolic foci in both annexes. The anatomopathological study detected bilateral ovarian adenocarcinoma compatible with metastases of pulmonary origin.

CT, MRI, and F-18 FDG PET for the detection of non-small-cell lung cancer (NSCLC): A protocol for a network meta-analysis of diagnostic test accuracy

BACKGROUND

Non-small-cell lung cancer (NSCLC) is a rare cancer in lung carcinomas and has been widely known as a difficult curable disease among all the tumors. However, early detection of malignant potential in patients with NSCLC has still been a huge challenge all around the world. CT, MRI, and F-18 FDG PET are all considered as good tests for diagnosing malignant NSCLC efficiently, but no recommended suggestion presents that which test among the 3 is the prior one in diagnose. We perform this study through network meta-analysis method, and to rank these tests using a superiority index.

METHODS AND ANALYSIS

PubMed, Embase.com, and the Cochrane Central Register of Controlled Trials (CENTRAL) will be searched from their inception to March 2018. We will include diagnostic tests which assessed the accuracy of CT, MRI, and F-18 FDG PET for diagnosing NSCLC. The risk of bias for each study will be independently assessed as low, moderate, or high using criteria adapted from Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Network meta-analysis will be performed using STATA 12.0 and R 3.4.1 software. The competing diagnostic tests will be ranked by a superiority index.

RESULTS

This study is ongoing, and will be submitted to a peer-reviewed journal for publication.

CONCLUSION

This study will provide systematically suggestions to select different diagnostic measures for detecting the early NSCLC.

ETHICS AND DISSEMINATION

Ethical approval and patient consent are not required since this study is a network meta-analysis based on published studies. The results of this network meta-analysis will be submitted to a peer-reviewed journal for publication.

PROSPERO REGISTRATION NUMBER

PROSPEROCRD42018094542.

Contrast-enhanced magnetic resonance imaging with a novel nano-size contrast agent for the clinical diagnosis of patients with lung cancer

Recent studies have indicated that magnetic resonance imaging (MRI) efficiently diagnoses lung cancer. However, the efficacy of MRI in diagnosing lung cancer requires improving for patients in the early stage of the disease. In the present study, a novel nano-sized contrast agent of chistosan/Fe₃O₄-enclosed bispecific antibodies (BsAbCENS) was introduced, which targeted carcino-embryonic antigen (CEA) and neuron-specific enolase (NSE) in lung cancer cells. The diagnostic efficacy of contrast-enhanced MRI with BsAbCENS (CEMRI-BsAbCENS) was investigated in a total of 182 patients with suspected lung cancer who had high serum levels of CEA and NSE. BsAbCENS was administered by pulmonary inhalation prior to the MRI scan. The results revealed that CEA and NSE were overexpressed in human lung cancer cell lines. BsAbCENS bound with CEA and NSE on the surface of human lung cancer cells and produced a higher signal intensity than MRI alone for the diagnosis of patients with lung cancer. The diagnostic data revealed that CEMRI-BsAbCENS diagnosed 124/182 lung cancer cases, whereas CEMRI only diagnosed 98/182, which was significantly less (P<0.01). In addition, the survival rate of patients with lung cancer diagnosed by CEMRI-BsAbCENS was significantly higher than the mean 5-year survival rate (P<0.01). Furthermore, the pharmacodynamics demonstrated that BsAbCENS was metabolized within 24 h. The results of the present study indicate that the efficacy and accuracy of lung cancer diagnosis are improved by CEMRI-BsAbCENS. In conclusion, these results provide a potential novel protocol for the diagnosis of tumors in patients with suspected early stage lung cancer.

The Impact of Staging by Positron-Emission Tomography on Overall Survival and Progression-Free Survival in Patients With Locally Advanced NSCLC

INTRODUCTION

We investigated the potential impact of stage migration because of positron-emission tomography (PET) scan staging on survival in the locally advanced (stage IIIA/B) NSCLC setting.

METHODS

In PROCLAIM, 598 patients with stage IIIA/B nonsquamous NSCLC (intent-to-treat population) were randomized to either pemetrexed plus cisplatin and concurrent thoracic radiotherapy for 3 cycles followed by 4 cycles of pemetrexed consolidation or etoposide plus cisplatin and concurrent thoracic radiotherapy for 2 cycles followed by a consolidation platinum-based doublet regimen for up to 2 cycles. Baseline PET scan (PET Yes versus No) was one of the stratification factors. Subgroup analyses (PET Yes versus No) of overall survival (OS) and progression-free survival (PFS) were conducted on the intent-to-treat population regardless of treatment, as the study did not show superior efficacy for either arm.

RESULTS

Majority (491 of 598; 82.1%) of patients had a baseline PET scan staging performed. A longer median OS (PET Yes versus No: 27.2 versus 20.8; hazard ratio = 0.81, p = 0.130) and an improved median PFS (PET Yes versus No: 11.3 versus 9.2; hazard ratio = 0.73, p = 0.012) were observed for patients with PET scans compared to those with conventional staging in both treatment arms.

CONCLUSIONS

Both a significantly improved PFS and a numerically longer OS in the PET Yes subgroup, compared to patients with conventional staging, are consistent with improved survival due to stage migration. The magnitude of differences in OS and PFS based on PET scan is a reminder of the potential for factors other than the therapeutic intervention to affect outcomes.

Diagnosing lung cancer using etoposide microparticles labeled with 99mTc

The diagnosis of lung cancer mostly occurs when the cancer is already in an advanced stage. In this situation, there are few options for the treatment and most of them have few chances of success. In this study, we developed and tested etoposide microparticles as a diagnostic agent for imaging lung cancer at early stages of development. We tested etoposide microparticles labeled with technetium 99m in inducted mice. The results demonstrated that over 10% of the total dose used was uptake by the tumor site. Also, the results showed that the microparticles had a good renal clearance and low uptake by liver and spleen. The data suggest that these micro-radiopharmaceuticals may be used for lung cancer imaging exam, especially single-photo emission computed tomography (SPECT).[Formula: see text].

Prognostic value of early response assessment using (18F)FDG-PET in patients with advanced non-small cell lung cancer treated with tyrosine-kinase inhibitors

The purpose of this meta-analysis was to determine the prognostic value of early response assessment using (18F)fluorodeoxyglucose (FDG)-positron emission thermography (PET) in patients with advanced non-small cell lung cancer (NSCLC) treated with tyrosine-kinase inhibitors (TKIs). MEDLINE, PubMed, Cochrane, EMBASE, and Google Scholar databases were searched until August 1, 2016 using the keywords non-small cell lung carcinoma, positron-emission tomography, fluorodeoxyglucose, prognosis, disease progression, survival, erlotinib, gefitinib, and afatinib. Inclusion criteria were studies of patients with stage III or IV NSCLC treated with a TKI and had response assessed by FDG-PET. Outcome measures were overall survival (OS) and progression-free survival (PFS). Of the 167 articles identified, 10 studies including 302 patients were included in the analysis. In 8 studies, patients were treated with erlotinib, and in 2 they were treated with gefitinib. The overall analysis revealed that early metabolic response was statistically associated with improved OS (HR=0.54; 95% CI 0.46 to 0.63; p<0.001), and with longer PFS (HR=0.23; 95% CI 0.17 to 0.33; p<0.001). Early response of patients with NSCLC treated with TKIs identified on FDG-PET is associated with improved OS and PFS.