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Kaida H, Kitajima K, Nakajo M, Ishibashi M, Matsunaga T, Minamimoto R, Hirata K, Nakatani K, Hung A, Hattori S, Yasuda T, Ishii K. Predicting tumor response and prognosis to neoadjuvant chemotherapy in esophageal squamous cell carcinoma patients using PERCIST: a multicenter study in Japan. Eur J Nucl Med Mol Imaging 2021; 48:3666-3682. [PMID: 33934168 DOI: 10.1007/s00259-021-05365-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 04/11/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the usefulness of the positron emission tomography response criteria in solid tumors 1.0 (PERCIST1.0) for predicting tumor response to neoadjuvant chemotherapy and prognosis and determine whether PERCIST improvements are necessary for esophageal squamous cell carcinoma (ESCC) patients. PATIENTS AND METHODS We analyzed the cases of 177 ESCC patients and examined the association between PERCIST and their pathological responses. Associations of whole-PERCIST with progression-free survival (PFS) and overall survival (OS) were evaluated by a Kaplan-Meier analysis and Cox proportional hazards model. To investigate potential PERCIST improvements, we used the survival tree technique to understand patients' prognoses. RESULTS There were significant correlations between the pathologic response and PERCIST of primary tumor (p < 0.001). The optimal cutoff value of the primary tumors' SULpeak response to classify pathologic responses was -50.0%. The diagnostic accuracy of SULpeak response was 87.3% sensitivity, 54.1% specificity, 68.9% accuracy, positive predictive value 60.5%, and negative predictive value 84.1%. Whole-PERCIST was significantly associated with PFS and OS. The survival tree results indicated that a high reduction of the whole SULpeak response was significantly correlated with the patients' prognoses. The cutoff values for the separation of prognoses were - 52.5 for PFS and - 47.1% for OS. CONCLUSION PERCIST1.0 can help predict tumor responses and prognoses. However, 18F-FDG-PET/CT tends to underestimate residual tumors in histopathological response evaluations. Modified PERCIST, in which the partial metabolic response is further classified by the SULpeak response (-50%), might be more appropriate than PERCIST1.0 for evaluating tumor responses and stratifying high-risk patients for recurrence and poor prognosis.
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Affiliation(s)
- Hayato Kaida
- Department of Radiology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Kazuhiro Kitajima
- Department of Radiology, Division of Nuclear Medicine and PET Center, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Masatoyo Nakajo
- Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-5-31, Sakuragaoka, Kagoshima, 890-8544, Japan
| | - Mana Ishibashi
- Division of Radiology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, 36-1, Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University of Faculty of Medicine, 36-1, Nishi-cho, Yonago, Tottori, 683-8504, Japan
| | - Ryogo Minamimoto
- Division of Nuclear Medicine, Department of Radiology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kenji Hirata
- Department of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, Kita15, Nishi 7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Koya Nakatani
- Department of Diagnostic Radiology, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, 710-8602, Japan
| | - Ao Hung
- Department of Biomedical Statistics, Osaka University Graduate School of Medicine, 2-2, Yamadagaoka, Suita, Osaka, 565-0871, Japan
| | - Satoshi Hattori
- Department of Biomedical Statistics, Osaka University Graduate School of Medicine, 2-2, Yamadagaoka, Suita, Osaka, 565-0871, Japan.,Institute for Open and Transdisciplinary Research Initiative, Osaka University, 2-2, Yamadagaoka, Suita, Osaka, 565-0871, Japan
| | - Takushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kazunari Ishii
- Department of Radiology, Kindai University Faculty of Medicine, 377-2, Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan
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Vogsen M, Bülow JL, Ljungstrøm L, Oltmann HR, Alamdari TA, Naghavi-Behzad M, Braad PE, Gerke O, Hildebrandt MG. FDG-PET/CT for Response Monitoring in Metastatic Breast Cancer: The Feasibility and Benefits of Applying PERCIST. Diagnostics (Basel) 2021; 11:723. [PMID: 33921580 DOI: 10.3390/diagnostics11040723] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/14/2021] [Accepted: 04/16/2021] [Indexed: 12/18/2022] Open
Abstract
Background: We aimed to examine the feasibility and potential benefit of applying PET Response Criteria in Solid Tumors (PERCIST) for response monitoring in metastatic breast cancer (MBC). Further, we introduced the nadir scan as a reference. Methods: Response monitoring FDG-PET/CT scans in 37 women with MBC were retrospectively screened for PERCIST standardization and measurability criteria. One-lesion PERCIST based on changes in SULpeak measurements of the hottest metastatic lesion was used for response categorization. The baseline (PERCISTbaseline) and the nadir scan (PERCISTnadir) were used as references for PERCIST analyses. Results: Metastatic lesions were measurable according to PERCIST in 35 of 37 (94.7%) patients. PERCIST was applied in 150 follow-up scans, with progression more frequently reported by PERCISTnadir (36%) than PERCISTbaseline (29.3%; p = 0.020). Reasons for progression were (a) more than 30% increase in SULpeak of the hottest lesion (n = 7, 15.9%), (b) detection of new metastatic lesions (n = 28, 63.6%), or both (a) and (b) (n = 9, 20.5%). Conclusions: PERCIST, with the introduction of PERCISTnadir, allows a graphical interpretation of disease fluctuation that may be beneficial in clinical decision-making regarding potential earlier termination of non-effective toxic treatment. PERCIST seems feasible for response monitoring in MBC but prospective studies are needed to come this closer.
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Sørensen JS, Vilstrup MH, Holm J, Vogsen M, Bülow JL, Ljungstrøm L, Braad PE, Gerke O, Hildebrandt MG. Interrater Agreement and Reliability of PERCIST and Visual Assessment When Using 18F-FDG-PET/CT for Response Monitoring of Metastatic Breast Cancer. Diagnostics (Basel) 2020; 10:E1001. [PMID: 33255442 PMCID: PMC7759893 DOI: 10.3390/diagnostics10121001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/15/2020] [Accepted: 11/21/2020] [Indexed: 01/14/2023] Open
Abstract
Response evaluation at regular intervals is indicated for treatment of metastatic breast cancer (MBC). FDG-PET/CT has the potential to monitor treatment response accurately. Our purpose was to: (a) compare the interrater agreement and reliability of the semi-quantitative PERCIST criteria to qualitative visual assessment in response evaluation of MBC and (b) investigate the intrarater agreement when comparing visual assessment of each rater to their respective PERCIST assessment. We performed a retrospective study on FDG-PET/CT in women who received treatment for MBC. Three specialists in nuclear medicine categorized response evaluation by qualitative assessment and standardized one-lesion PERCIST assessment. The scans were categorized into complete metabolic response, partial metabolic response, stable metabolic disease, and progressive metabolic disease. 37 patients with 179 scans were included. Visual assessment categorization yielded moderate agreement with an overall proportion of agreement (PoA) between raters of 0.52 (95% CI 0.44-0.66) and a Fleiss kappa estimate of 0.54 (95% CI 0.46-0.62). PERCIST response categorization yielded substantial agreement with an overall PoA of 0.65 (95% CI 0.57-0.73) and a Fleiss kappa estimate of 0.68 (95% CI 0.60-0.75). The difference in PoA between overall estimates for PERCIST and visual assessment was 0.13 (95% CI 0.06-0.21; p = 0.001), that of kappa was 0.14 (95% CI 0.06-0.21; p < 0.001). The overall intrarater PoA was 0.80 (95% CI 0.75-0.84) with substantial agreement by a Fleiss kappa of 0.74 (95% CI 0.69-0.79). Semi-quantitative PERCIST assessment achieved significantly higher level of overall agreement and reliability compared with qualitative assessment among three raters. The achieved high levels of intrarater agreement indicated no obvious conflicting elements between the two methods. PERCIST assessment may, therefore, give more consistent interpretations between raters when using FDG-PET/CT for response evaluation in MBC.
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Affiliation(s)
- Jonas S. Sørensen
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark; (M.V.); (P.-E.B.); (O.G.); (M.G.H.)
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark; (M.H.V.); (J.H.); (J.L.B.); (L.L.)
| | - Mie H. Vilstrup
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark; (M.H.V.); (J.H.); (J.L.B.); (L.L.)
| | - Jorun Holm
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark; (M.H.V.); (J.H.); (J.L.B.); (L.L.)
| | - Marianne Vogsen
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark; (M.V.); (P.-E.B.); (O.G.); (M.G.H.)
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark; (M.H.V.); (J.H.); (J.L.B.); (L.L.)
- Department of Oncology, Odense University Hospital, 5000 Odense, Denmark
- Odense Patient Data Explorative Network (OPEN), Odense University Hospital, 5000 Odense, Denmark
| | - Jakob L. Bülow
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark; (M.H.V.); (J.H.); (J.L.B.); (L.L.)
| | - Lasse Ljungstrøm
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark; (M.H.V.); (J.H.); (J.L.B.); (L.L.)
| | - Poul-Erik Braad
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark; (M.V.); (P.-E.B.); (O.G.); (M.G.H.)
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark; (M.H.V.); (J.H.); (J.L.B.); (L.L.)
| | - Oke Gerke
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark; (M.V.); (P.-E.B.); (O.G.); (M.G.H.)
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark; (M.H.V.); (J.H.); (J.L.B.); (L.L.)
| | - Malene G. Hildebrandt
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark; (M.V.); (P.-E.B.); (O.G.); (M.G.H.)
- Department of Nuclear Medicine, Odense University Hospital, 5000 Odense, Denmark; (M.H.V.); (J.H.); (J.L.B.); (L.L.)
- Odense Patient Data Explorative Network (OPEN), Odense University Hospital, 5000 Odense, Denmark
- Centre for Personalized Response Monitoring in Oncology (PREMIO), Odense University Hospital, 5000 Odense, Denmark
- Centre for Innovative Medical Technology (CIMT), Odense University Hospital, 5000 Odense, Denmark
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