A hierarchical prognostic model for risk stratification in patients with early breast cancer according to 18F-fluorodeoxyglucose uptake and clinicopathological parameters

Department of Medicine/석사본 연구의 목적은 수술 전 항암 요법을 받지 않은 조기 유방암 환자에서 양전자 컴퓨터 단층 촬영 영상의 원발종양 18F-fludeoxyglucose 섭취 정도가 환자의 재발을 예측하는 예후 인자임을 확인하고 더 나아가 고위험군 환자를 분류하는데 있어 다른 예후 인자들과 어떻게 상호작용하는지 분석하는 것이다. 대상 및 방법: 2008년 1월부터 2013년 12월까지 수술 전 항암 요법을 받지 않은 524 명의 조기 유방암 환자를 모집하였다. 콕스-비례위험모형을 통해 최대 표준화섭취계수 (SUVmax) 및 임상병리적 인자들 중 환자의 무 재발 생존과 관련된 예후인자들을 찾았다. 그 후 찾은 인자들을 이용하여 분류 및 회귀 트리 델 분석을 시행하고 재발 위험에 따라 환자를 층계화 할 때 예후 인자들끼리 어떻게 상호작용 하는지를 분석한 예후 모델을 제시하였다. 마지막으로 카플란마이어법 및 로그순위법을 통해 층계화 된 그룹들의 생존곡선을 비교하였다. 결과: 추적관찰 기간의 중위값은 46.2 개월이었고, 추적관찰 중 재발한 환자는 총 31명이었다 (국소전이 8명, 원격전이 23명). 일변량 분석에서는 종양의 SUVmax (>6.75), 크기 (>2.0 cm), 그리고 삼중음성 유형이 나쁜 예후 인자였다. 그리고 다변량 분석에서는 SUVmax 만이 독립적인 나쁜 예후 인자였다 (p=0.028). 분류 및 회귀 트리 모델 분석은 재발 위험도에 따라 환자를 네 그룹으로 나누었다(그룹 1 (SUVmax 6.75 그리고크기2.0 cm); 그룹 2 (SUVmax 6.75, 크기>2 cm, 그리고루미날 A 또는삼중음성 유형); 그룹 3 (SUVmax 6.75, 종양의 크기 >2.0 cm, 그리고루미날 B 혹은상피성장인자 수용체 과발현 유형); 그룹 4 (SUVmax >6.75)). 각 그룹의 무재발 5년 생존율은 다음과 같았다: 95.9% (그룹 1), 98% (그룹 2), 82.8% (그룹 3), and 85.4% (그룹 4). 그룹 3 과 그룹 4 는 그룹 1 과 그룹 2 보다 나쁜 예후를 보였다. 결론: 조기 유방암 환자에서 원발 종양의 높은 SUVmax 값은 독립적인 나쁜 예후 인자였다. SUVmax 값이 낮더라도 종양의 크기가 2 cm 이상인 루미날 B 혹은 상피성장인자 수용체 과발현 유형은 SUVmax 값이 높은 그룹만큼이나 안 좋은 예후를 보였다.open석

Evaluation of 18F-FDG PET/CT Parameters for Detection of Lymph Node Metastasis in Cutaneous Melanoma

Purpose: The purpose of this study was to investigate the value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) parameters in the detection of regional lymph node (LN) metastasis in patients with cutaneous melanoma. Methods: We evaluated patients with cutaneous melanoma who underwent FDG PET/CT for initial staging or recurrence evaluation. A total of 103 patients were enrolled, and 165 LNs were evaluated. LNs that were confirmed pathologically or by follow-up imaging were included in this study. PET parameters, including maximum standardized uptake value (SUVmax), total lesion glycolysis and tumour-to-liver ratio, were used to determine the presence of metastases, and the results were compared with CT-determined LN metastasis. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off values of the FDG PET parameters. Results: A total of 93 LNs were malignant, and 84 LNs were smaller than 10 mm. In all 165 LNs, an SUVmax of >2.51 showed a sensitivity of 73.1%, a specificity of 88.9%, and an accuracy of 80.0% in detecting metastatic LNs. CT showed a higher specificity (87.3%) and lower accuracy (65.5%). For non-enlarged regional LNs (<10 mm), an SUVmax cut-off value of 1.4 showed the highest negative predictive value (81.3%). For enlarged LNs (≥10 mm), an SUVmax cut-off value of 2.4 showed the highest sensitivity (90.7%) and accuracy (88.9%) in detecting metastatic LNs. Conclusions: In patients with cutaneous melanoma, an SUVmax of >2.4 showed a high sensitivity (91%) and accuracy (89%) in detecting metastasis in LNs ≥1 cm, and LNs <1 cm with an SUVmax <1.4 were likely to be benign.ope

Correlation Analysis and Prognostic Impact of (18)F-FDG PET and Excision Repair Cross-Complementation Group 1 (ERCC-1) Expression in Non-Small Cell Lung Cancer

PURPOSE: The aim of this study was to determine the relationship between [(18)]-2-fluoro-2-deoxy-D-glucose (FDG) uptake and excision repair cross-complementation group 1 (ERCC-1) expression and to evaluate the prognostic effect of these two factors in resectable non-small cell lung cancer (NSCLC) patients. METHODS: We retrospectively reviewed 212 patients with resectable NSCLC who underwent FDG positron emission tomography/computed tomography (PET/CT) scan for cancer staging and ERCC-1 expression analysis between January 2008 to December 2011. All patients were then followed-up for survival analysis. Semiquantitative evaluation of ERCC-1 was performed with the H-scoring system and was correlated with maximum standardized uptake value (SUVmax) of NSCLC. Univariate and multivariate analyses were performed to evaluate for FDG uptake and ERCC-1 expression predicting overall survival. RESULTS: In 212 patients (139 male, median age 68 ± 9.11), 112 patients had ERCC-positive tumors and 100 patients had ERCC-negative tumors. There was no significant difference in SUVmax between ERCC-1-positive tumors (8.02 ± 5.40) and ERCC-1-negative tumors (7.57 ± 6.56, p = 0.584). All patients were followed-up for a median of 40.5 months (95 % confidence interval [CI], 38.5-42.2 months). Univariate analysis and multivariate analysis for all patients showed that both ERCC-1 expression (hazard ratio [HR], 2.78; 95 % CI, 1.20-6.47) and FDG uptake (HR, 4.50; 95 % CI, 2.07-9.77) independently predicted overall survival. CONCLUSIONS: We have found no statistical correlation between FDG uptake and ERCC-1 expression in NSCLC. However, both higher FDG uptake and positive ERCC-1 expression are independent predictive markers of prognosis, suggesting that both should be obtained during patient workup.ope

A Comparison Study of Esophageal Findings on (18)F-FDG PET/CT and Esophagogastroduodenoscopy

Purpose : The aim of this study was to compare the esophageal findings of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography?computed tomography (18F-FDG PET/CT) and esophagogastroduodenoscopy (EGD). Methods : We retrospectively reviewed 18F-FDG PET/CT and EGD findings of 369 subjects who underwent medical examination between January 2014 and December 2014. The range and intensity of esophageal 18F-FDG uptake were visually analyzed. The maximum standardized uptake value (SUVmax) of the esophagus and around the esophagogastric (EG) junction was measured. EGD results were provided by the gastroenterologist. We compared the esophageal findings obtained using 18F-FDG PET/CT and EGD. Results : There were typical linear FDG uptakes in 18F-FDG PET/CT patients who underwent EGD the same day. In visual analysis of the range and intensity of the 18F-FDG uptake, the patients who underwent 18F-FDG PET/CT and EGD on the same day showed relatively diffuse and discernible 18F-FDG uptake in the esophagus. Reflux esophagitis was diagnosed in 59 subjects, and 27 of these were classified as higher than Los Angeles classification A. With an increasing degree of reflux esophagitis observed on EGD, the SUVmax in the esophagus and around the EG junction was also increased. Conclusion : Our study showed that FDG uptake at the esophagus or the EG junction might be clinically significantly related to esophagitis. However, EGD performed before 18F-FDG PET/CT on the same day may affect the esophageal 18F-FDG uptake.ope

A hierarchical prognostic model for risk stratification in patients with early breast cancer according to 18 F-fludeoxyglucose uptake and clinicopathological parameters

This study was to investigate a hierarchical prognostic model using clinicopathological factors and 18 F-fludeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) for recurrence-free survival (RFS) in patients with early breast cancer who underwent surgery without neoadjuvant chemotherapy. A total of 524 patients with early breast cancer were included. The Cox proportional hazards model was used with clinicopathological variables and maximum standardized uptake value (SUVmax) on PET/CT. After classification and regression tree (CART) modeling, RFS curves were estimated using the Kaplan-Meier method and differences in each risk layer were assessed using the log-rank test. During a median follow-up of 46.2 months, 31 (5.9%) patients experienced recurrence. The CART model identified four risk layers: group 1 (SUVmax ≤6.75 and tumor size ≤2.0 cm); group 2 (SUVmax ≤6.75 and Luminal A [LumA] or TN tumor >2.0 cm); group 3 (SUVmax ≤6.75 and Luminal B [LumB] or human epidermal growth factor receptor 2 [HER2]-enriched] tumor >2.0 cm); group 4 (SUVmax >6.75). Five-year RFS was as follows: 95.9% (group 1), 98% (group 2), 82.8% (group 3), and 85.4% (group 4). Group 3 or group 4 showed worse prognosis than group 1 or group 2 (group 1 vs. group 3: P = 0.040; group 1 vs. group 4: P 6.75) in primary breast cancer was an independent factor for poor RFS. In patients with low SUVmax, LumB or HER2-enriched tumor >2 cm was also prognostic for poor RFS, similar to high SUVmax.ope

Risk Stratification of Thyroid Incidentalomas Found on PET/CT: The Value of Iodine Content on Noncontrast Computed Tomography

BACKGROUND: The Hounsfield unit (HU) ratio of thyroid nodules was assessed compared to the contralateral thyroid lobe on noncontrast computed tomography (CT) to stratify further the risk of malignancy in thyroid incidentalomas found on (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/CT (PET/CT). METHODS: This retrospective analysis included 82 patients who had thyroid incidentalomas on PET/CT in 2011. On PET/CT, the maximal standardized uptake value ratios of the thyroid nodule compared to liver (T/BSUV) and the HU ratios of the thyroid nodule compared to contralateral thyroid lobe (T/BHU) were calculated. Diagnostic performances of the T/BSUV and T/BHU were compared. RESULTS: The area under the curve of T/BHU was higher than that of T/BSUV (0.941 vs. 0.689, p 0.68. In this study, there were 18 nodules with nondiagnostic (n = 7) or atypia of undetermined significance or follicular lesion of undetermined significance cytologies (n = 11) after fine-needle aspiration biopsy (FNAB). When the T/BHU cutoff value was applied, three (60%) of the five nodules with a T/BHU of ≤0.68 were found to be papillary carcinomas. The remaining 13 nodules with a T/BHU of >0.68 were all benign with a risk of malignancy of 0%. CONCLUSIONS: T/BHU is a simple and effective parameter to stratify the risk of malignancy in thyroid incidentalomas found on PET/CT. This may be of clinical relevance in those nodules with nondiagnostic or undetermined significance cytologies upon FNAB in the scheme of current clinical practice.ope