Choon-Young Kim

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

BackgroundThe 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.MethodsOne 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.ResultsThe 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.ConclusionsIntratumoral 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.

Quantitative metabolic parameters measured on F-18 FDG PET/CT predict survival after relapse in patients with relapsed epithelial ovarian cancer

OBJECTIVE This study aimed to evaluate the prognostic value of quantitative metabolic parameters measured on F-18 FDG PET/CT (FDG PET/CT) at the time of the first relapse in patients with relapsed epithelial ovarian cancer (EOC). METHODS Fifty-six relapsed EOC patients were retrospectively included. Quantitative metabolic parameters including maximum standardized uptake value (SUVmax), whole-body metabolic tumor volume (WBMTV), and whole-body total lesion glycolysis (WBTLG) were measured on FDG PET/CT at the time of the first relapse. Post-relapse survival (PRS) was calculated from the date of diagnosis of relapsed disease to the date of death or last follow-up. Univariate and multivariate analyses for PRS were performed using clinical and quantitative metabolic parameters. RESULTS Thirty-two patients died from the disease during the follow-up period (median: 46.2 months). On univariate and multivariate analyses, the platinum-free interval, type of second-line treatment, WBMTV, and WBTLG were all significant prognostic factors for PRS. The subgroup of patients who were platinum-sensitive with low WBMTV and low WBTLG showed better prognosis, when compared with other subgroups (log-rank test, p<0.001). Patients treated with secondary cytoreductive surgery (SCS) followed by second-line chemotherapy showed significantly longer duration of PRS than patients treated with second-line chemotherapy only (mean PRS=61 vs. 36 months, χ(2)=8.68, p=0.032). CONCLUSION Our results suggest that quantitative metabolic parameters measured on FDG PET/CT at the time of the first relapse have significant predictive values for PRS. Incorporating quantitative metabolic parameters and conventional clinical parameters has a superior prognostic discrimination compared with conventional clinical parameters alone.

Prognostic Significance of Intratumoral Metabolic Heterogeneity on 18F-FDG PET/CT in Pathological N0 Non-Small Cell Lung Cancer.

Purpose The aim of the study was to evaluate the prognostic significance of intratumoral metabolic heterogeneity on pretreatment 18F-FDG PET/CT in patients with lung cancer who were pathologically N0 (pN0) after curative surgical resection. Methods We examined 119 patients (M/F = 79/40; mean age, 64.6 ± 9.0 years) who had undergone pretreatment 18F-FDG PET/CT and were diagnosed as pN0 after curative surgery for adenocarcinoma (ADC; n = 67) or squamous cell carcinoma (SQCC; n = 52). Heterogeneity factor (HF) and other metabolic parameters (SUVmax, metabolic tumor volume [MTV] and total lesion glycolysis [TLG]) for the primary lesions were measured, and the results were analyzed for recurrence. The HF, defined as the derivative of the volume-threshold function from 20% to 80%, was computed for primary lesions. Univariate and multivariate analyses for recurrence were performed using the Kaplan-Meier method and using the Cox proportional hazards model. Results SUVmax, MTV, TLG, and HF were statistically different between patients with ADC and SQCC. Forty-one (34.5%) of 119 patients experienced recurrence (ADC, 25/67 = 37.3% vs. SQCC, 16/52 = 30.8%). Results of univariate analysis indicate that SUVmax, MTV, TLG, and HF in ADC and TLG and HF in SQCC were predictors for recurrence. After adjusting for sex, age, and histological grade in multivariate analysis, high SUVmax, MTV, TLG, and HF in ADC exhibited an association with increased risk of recurrence. Conclusions Metabolic parameters and heterogeneity of primary tumor on pretreatment 18F-FDG PET/CT can predict recurrence in pN0 NSCLC patients of ADC type who have undergone curative surgery but not in patients of SQCC type.

Preoperative Prediction of Cervical Lymph Node Metastasis Using Primary Tumor SUVmax on 18F-FDG PET/CT in Patients with Papillary Thyroid Carcinoma.

Objectives The aim of the current study was to evaluate the value of preoperative 18F-FDG (FDG) PET/CT in predicting cervical lymph node (LN) metastasis in patients with papillary thyroid carcinoma (PTC). Methods One hundred and ninety-three newly diagnosed PTC patients (M: F = 25:168, age = 46.8 ± 12.2) who had undergone pretreatment FDG PET/CT and had neck node dissection were included in this study. The FDG avidity of the primary tumor and the SUVmax of the primary tumor (pSUVmax) were analyzed for prediction of LN metastasis. Detectability by ultrasonography (US) and FDG PET/CT for cervical LN metastasis were also assessed and compared with the pSUVmax. Results The FDG avidity of the primary tumor was identified in 118 patients (FDG avid group: 61.0%, M: F = 16:102, age 47.0 ± 12.7 years) and pSUVmax ranged from 1.3 to 35.6 (median 4.6) in the FDG avid group. The tumor size in the FDG avid group was bigger and there was a higher incidence of LN metastasis compared to the FDG non-avid group (0.93 vs. 0.59 cm, p <0.001 and 49.2 vs. 33.3%, p <0.05). In the FDG avid group, patients with LN metastasis had higher pSUVmax than patients without LN metastasis (8.7 ± 8.3 vs. 5.7 ± 5.1, p <0.001). The incidence of central LN metastasis in patients with a pSUVmax >4.6 was 54%; however, the detectability of central LN metastasis by US and FDG PET/CT were 10.3% and 3.6%, respectively. Conclusion A high FDG avidity of the primary tumor was related to LN metastasis in PTC patients. Therefore, patients with a high pSUVmax should be cautiously assessed for LN metastasis and might need a more comprehensive surgical approach.

Quantification of Intratumoral Metabolic Macroheterogeneity on 18F-FDG PET/CT and Its Prognostic Significance in Pathologic N0 Squamous Cell Lung Carcinoma.

Purpose This study aimed to develop a novel quantification method for intratumoral metabolic macroheterogeneity (IMMH) on 18F-FDG PET/CT and evaluate its prognostic significance in pathologic N0 (pN0) squamous cell lung carcinoma (SQCLC) patients. Patients and Methods A total of 83 patients who underwent pretreatment 18F-FDG PET/CT and were diagnosed with pN0 SQCLC after curative surgery were examined. Patients with tumor measuring greater than 2 cm were included. Metabolic parameters (SUVmax, metabolic tumor volume, and total lesion glycolysis) for the primary lesions were calculated on the 18F-FDG PET/CT, and IMMH was quantified as the macroheterogeneity factor (MHF), defined as surface/spherical surface area having volume of the primary tumor multiplied by the sphericity. Heterogeneity of the primary tumor was also visually assessed (visual heterogeneity score) and compared with MHF. Univariate and multivariate analyses for recurrence were performed using the Cox proportional hazards regression. Results Recurrence was observed in 27 (32.5%) of 83 patients during follow-up period (37.6 ± 25.5 months). Significant correlations were observed between the visual heterogeneity score and the MHF (R = 0.534, P < 0.001). Macroheterogeneity factor was significantly higher in patients who experienced recurrence (median, 1.073 vs 1.016; P = 0.004). Univariate analysis showed that MHF was only significant prognostic factor for recurrence (P = 0.019), and multivariate analysis after adjusting for age, sex, tumor size, histologic grade, and pathologic T stage, high MHF exhibited an association with increased risk of recurrence. Conclusions New quantification method for IMMH on 18F-FDG PET/CT was developed, and the heterogeneity parameter MHF was well correlated with visual heterogeneity. Macroheterogeneity factor on pretreatment 18F-FDG PET/CT was the sole prognostic factor predicting recurrence in pN0 SQCLC patients.

Clinical impact of (18) F-FDG positron emission tomography/CT on adenoid cystic carcinoma of the head and neck.

The purpose of this retrospective study was to assess the diagnostic value of 18F‐fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT and the prognostic value of metabolic PET parameters in patients with adenoid cystic carcinoma of the head and neck (ACCHN).

Incidental detection of increased (18)F-FDG uptake and its follow-up in patients with granulomatous prostatitis after BCG treatment for urinary bladder cancer.

Incidental prostate uptake of fluorine-18-fluorodeoxyglucose in positron emission tomography/computed tomography ((18)F-FDG PET/CT) may represent malignancies like prostate malignancy, inflammation or benign prostatic lesions. We report two cases of bacillus Calmette-Guérin (BCG)-induced granulomatous prostatitis that showed (18)F-FDG uptake of the prostate gland on (18)F-FDG PET/CT in patients who had previously received intravesical BCG treatment for bladder cancer. The degree of (18)F-FDG uptake was decreased on the follow-up PET/CT scan after one year, without any specific treatment.

Emptying effect of massage on parotid gland radioiodine content.

BackgroundTo prevent salivary dysfunction in thyroid cancer patients who have undergone radioiodine ablation, massaging the parotid gland (PG) is presumed to be helpful for the removal of radioiodine. The purpose of this study was to evaluate the effect of PG massage in the removal of radioiodine from the PG. MethodsForty-four patients (female, 38; 49.1±11.0 years) who underwent total thyroidectomy followed by I-131 ablation were included in this prospective study. Three serial salivary gland scans were performed 2 h after administration of I-123 in thyroid hormone withdrawal status. The patients were divided into two groups. There was a 1-min (or 2-min) interval between the first and second scans for control, followed by the performance of PG massage for 1 min (or 2 min) between the second and third scans. Changes in uptakes were calculated between the first and second scans (control) and between the second and third scans (massage). ResultsThe mean change in uptake at the 1-min massage was 0.97±11.27%, whereas that at the 1-min control was 11.54±5.59% (P<0.001). The mean change in uptake at the 2-min massage was also significantly lower than that at the 2-min control (11.11±6.97 vs. −0.85±9.78%, P<0.001). However, no statistical difference was observed between the mean changes in uptake after 1- and 2-min massages (P=0.573). ConclusionPG massage reduced the radioiodine uptake in the PG, and the effect of PG massage for 1 min was comparable with that of PG massage for 2 min. PG massage can be applied to thyroid cancer patients who receive radioiodine therapy to reduce PG dysfunction.