Tumor heterogeneity: morphological, molecular and clinical implications

Predictive value of intratumoral heterogeneity of F-18 FDG uptake for characterization of thyroid nodules according to Bethesda categories of fine needle aspiration biopsy results

The current study was aimed to investigate the clinical value of intratumoral heterogeneity of F-18 FDG uptake for characterization of thyroid nodule (TN) with inconclusive fine-needle aspiration biopsy (FNAB) results. The current study enrolled 200 patients who showed F-18 FDG incidentaloma and were performed FNAB. The intratumoral heterogeneity of F-18 FDG uptake was represented as the heterogeneity factor (HF), defined as the derivative (dV/dT) of a volume-threshold function for a primary tumor. The diagnostic and predictive values of HF and F-18 FDG PET/CT parameters were evaluated for characterization of inconclusive FNAB results. Among F-18 FDG PET/CT parameters, SUVmax, MTV, and TLG of malignant group were statistically higher than those of Bethesda category of suspicious malignant group. However, HF values were not statistically different between the groups of Bethesda categories (Kruskal-Wallis statistics, 9.924; p = 0.0774). In ROC analysis, when HF > 2.751 was used as cut-off value, the sensitivity and specificity for prediction of malignant TN were 100 % (95 % CI 69.2-100 %) and 60 % (95 % CI 42.1-76.1 %), respectively. The AUC was 0.826 (95 % CI 0.684-0.922) and standard error was 0.0648 (p < 0.0001). In conclusion, the intratumoral heterogeneity of F-18 FDG uptake represented by HF could be a predictor for characterization of TN with inconclusive FNAB results. Additional large population-based prospective studies are needed to validate the diagnostic utility of HF of F-18 FDG PET/CT.

Determination of regional lymph node status using (18)F-FDG PET/CT parameters in oesophageal cancer patients: comparison of SUV, volumetric parameters and intratumoral heterogeneity

OBJECTIVE

We aimed to investigate whether the standardized uptake values, volumetric parameters and intratumoral heterogeneity of fluorine-18-fludeoxyglucose ((18)F-FDG) uptake could predict regional lymph node (rLN) metastasis in oesophageal cancer.

METHODS

51 patients with surgically resected oesophageal cancer were included in the present study. The (18)F-FDG positron emission tomography (PET)/CT findings and rLN metastasis were compared with the histopathological results. The intratumoral metabolic heterogeneity was represented by the heterogeneity factor (HF), which was determined for each patient. Univariate and multivariate analyses were used to analyse the associations between the rLN metastasis and clinical findings, standardized uptake values, metabolic tumour volume (MTV), total lesion glycolysis (TLG) and HF.

RESULTS

The rLN(+) group showed statistically significant higher values of MTV (median, 13.59 vs 6.6; p = 0.0085), TLG (median, 119.18 vs 35.96; p = 0.0072) and HF (median, 3.07 vs 2.384; p = 0.0002) than the rLN(-) group. Univariate analysis showed that maximum standardized uptake value, mean standardized uptake value, MTV, TLG and HF were significantly associated with pathologic rLN involvement. However, in multivariate analysis, the HF was a potent associated factor for the prediction of pathologic rLN metastasis in oesophageal cancer.

CONCLUSION

In conclusion, (18)F-FDG PET/CT parameters such as maximum standardized uptake value, mean standardized uptake value, MTV, TLG and HF were useful for the prediction of pathologic rLN status in patients with oesophageal cancer. However, HF might be the most powerful predictor of rLN metastasis of patients with oesophageal cancer.

ADVANCES IN KNOWLEDGE

Assessment of intratumoral heterogeneity of (18)F-FDG PET/CT may be a useful adjunct for rLN staging of oesophageal cancer.

Intratumoral Heterogeneity of Subcutaneous Nodules in a Never-Smoker Woman of Lung Squamous Cell Carcinoma Detected on 18F-Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography: A Case Report

Subcutaneous tissue is a rare site of metastasis, accounting for only 1-2% of all lung neoplasms. Positron emission tomography (PET) using ¹⁸F-fluorodeoxyglucose (FDG) has been reported to increase the diagnostic accuracy of subcutaneous metastasis. A 58-year-old woman presented with complaints of dry coughing, in which three positive subcutaneous nodules were found on ¹⁸F-FDG positron emission tomography and computed tomography (PET/CT). Pathologic examination confirmed that each of the nodules contained 1) necrotic fat, 2) small amounts of blood cells and glandular epithelium, and 3) subcutaneous metastasis of moderately differentiated lung squamous cell carcinoma, respectively. Although PET/CT is useful for the detection of subcutaneous metastasis of primary lung cancer, we noted heterogeneous accumulation of ¹⁸F-FDG in subcutaneous tumors. This case highlights the importance of obtaining histological confirmation of malignant diseases whenever possible.

Prognostic implication of intratumoral metabolic heterogeneity in invasive ductal carcinoma of the breast

Background

The purpose of this study was to evaluate the prognostic implication of findings of intratumoral metabolic heterogeneity on pretreatment ¹⁸F-FDG PET/CT scans in patients with invasive ductal carcinoma (IDC) of the breast.

Methods

One hundred and twenty-three female IDC patients who underwent pretreatment ¹⁸F-fluorodeoxyglucose positron-emission tomography/computed tomography (¹⁸F-FDG PET/CT) scans were retrospectively evaluated in this study. The heterogeneity factor (HF) defined as the derivative (dV/dT) of a volume threshold function from 40% to 80%, was computed for each primary tumor. Other metabolic PET parameters (maximum standardized uptake value [SUVmax], metabolic tumor volume [MTV], and total lesion glycolysis [TLG]) were measured. The HF was compared with clinicopathologic factors and other PET parameters. Univariate and multivariate analyses for the overall survival (OS) were performed.

Results

The HF ranged from 0.02 to 6.72 (mean, 0.35 ± 0.82) and significantly correlated with MTV (r = 0.955; p < 0.0001) and TLG (r = 0.354; p = 0.0001). The HF was significantly higher (implying more heterogeneity) in tumors with higher T and N stages. The optimal cut-off values for the OS determined using a receiver operating characteristic (ROC) curve were 0.34 for the HF, 5.6 for SUVmax, 8.55 cm³ for MTV, and 14.43 for TLG. The OS rate among the 123 patients was 86.2%. T stage (1, 2 vs. 3, 4), N stage (0, 1 vs. 2, 3), M stage (0 vs. 1), ER status (+ vs. –), SUVmax (≤ 5.6 vs. > 5.6), MTV (≤ 8.55 cm³ vs. > 8.55 cm³), TLG (≤ 14.43 vs. > 14.43), and HF (< 0.34 vs. ≥ 0.34) affected the OS on univariate analysis. After adjustment for the effects of TNM stage and ER status, the HF and MTV were significant predictors of OS. Among the PET parameters, the best prognostic factor for OS was the HF.

Conclusions

Intratumoral metabolic heterogeneity correlated closely with the MTV and significantly affected the OS in IDC patients. The HF may act as a robust surrogate marker for the prediction of OS in IDC patients.

Landscape phage ligands for PC3 prostate carcinoma cells

Tumor-specific cytotoxicity of drugs can be enhanced by targeting them to tumor receptors using tumor-specific ligands. Phage display technology with its high throughput capacity for the analysis of targeting ligands possessing specific binding properties represents a very attractive tool in the quest for molecular ligands. Also, current phage nanobiotechnology concepts allow the use of intact phage particles and isolated phage coat proteins per se as components of nanomedicines. Herein, we describe the use of two landscape phage libraries to obtain phage ligands against PC3 prostate carcinoma cells. Following a very stringent selection scheme, we were able to identify three phage ligands, bearing the fusion peptides, DTDSHVNL, DTPYDLTG and DVVYALSDD that demonstrated specificity and selectivity to PC3 cells based on target-association assays, microscopy and flow cytometry. The phage ligands and their fusion coat proteins can be used as navigating modules in both therapeutic and diagnostic approaches to prostate carcinoma.

Insulin-like growth factor binding protein 2: gene expression microarrays and the hypothesis-generation paradigm

A major goal of modern medicine is to identify key genes and their products that are altered in the diseased state and to elucidate the molecular mechanisms underlying disease development, progression, and resistance to therapy. This is a daunting task given the exceptionally high complexity of the human genome. The paradigm for research has historically been hypothesis-driven despite the fact that the hypotheses under scrutiny often rest on tenuous subjective grounds or are derived from and dependent on chance observation. The imminent deciphering of the complete human genome, coupled with recent advances in high-throughput bioanalytical technology, has made possible a new paradigm in which data-based hypothesis-generation is the initial step in the investigative process, followed by hypothesis-testing. Genomics technologies are the primary source of the new hypothesis-generating capabilities that are now empowering biomedical researchers. The synergistic interaction between contemporary genomics technologies and the hypothesis-generation paradigm is well-illustrated by the discovery and subsequent ongoing study of the role of insulin-like growth factor binding protein 2 (IGFBP2) in human glioma biology. Using gene expression microarray technology, the IGFBP2 gene was recently found to be highly and differentially overexpressed in the most advanced grade of human glioma, glioblastoma. Based on this discovery, subsequent functional studies were initiated that suggest that IGFBP2 overexpression may contribute to the invasive nature of glioblastoma, and that IGFBP2 may exert its function via a newly identified novel binding protein. The IGFBP2 story is but one example of the power and potential of the new molecular methodologies that are transforming modern diagnostic and investigative neuropathology.