Glycolytic activity in breast cancer using 18F-FDG PET/CT as prognostic predictor: A molecular phenotype approach / Actividad glicolítica en el cancer de mama mediante 18F-FDG PET/TC como predictor pronóstico: aproximación del fenotipo molecular

Aim. To explore the relationship between basal 18F-FDG uptake in breast tumors and survival in patients with breast cancer (BC) using a molecular phenotype approach. Material and Methods. This prospective and multicentre study included 193 women diagnosed with BC. All patients underwent an 18F-FDG PET/CT prior to treatment. Maximum standardized uptake value (SUVmax) in tumor (T), lymph nodes (N), and the N/T index was obtained in all the cases. Metabolic stage was established. As regards biological prognostic parameters, tumors were classified into molecular sub-types and risk categories. Overall survival (OS) and disease free survival (DFS) were obtained. An analysis was performed on the relationship between semi-quantitative metabolic parameters with molecular phenotypes and risk categories. The effect of molecular sub-type and risk categories in prognosis was analyzed using Kaplan-Meier and univariate and multivariate tests. Results. Statistical differences were found in both SUVT and SUVN, according to the molecular sub-types and risk classifications, with higher semi-quantitative values in more biologically aggressive tumors. No statistical differences were observed with respect to the N/T index. Kaplan–Meier analysis revealed that risk categories were significantly related to DFS and OS. In the multivariate analysis, metabolic stage and risk phenotype showed a significant association with DFS. Conclusion. High-risk phenotype category showed a worst prognosis with respect to the other categories with higher SUVmax in primary tumor and lymph nodes (AU)

Objetivo. Analizar la relación entre la captación basal de 18F-FDG en tumores mamarios y la supervivencia en pacientes con cancer de mama (CM) bajo la aproximación del fenotipo molecular. Material y métodos. Este estudio prospectivo y multicentrico incluyó 193 mujeres diagnosticadas de CM. Todas las pacientes fueron sometidas a una 18F-FDG PET/TC previa al tratamiento. Se obtuvo el SUVmax en el tumor (T), ganglios linfáticos (N) así como el índice N/T en todos los casos. Además se determinó el estadio metabólico. Atendiendo a los factores biológicos pronósticos, los tumores fueron clasificados en subtipos moleculares y categorias de riesgo. Se obtuvo tanto la supervivencia global (SG) como la supervivencia libre de enfermedad (SLE). Se estudió la relación entre los parámetros metabólicos semicuantitativos con los fenotipos moleculares y las categorías de riesgo. Se analizó el efecto del subtipo molecular y las categorías de riesgo en el pronóstico mediante análisis de Kaplan–Meier y test uni y multivariantes. Resultados. Se encontraron diferencias estadísticamente significativas en tanto el SUVT como el SUVN, deacuerdo a los fenotipos moleculares y las categorías de riesgo, con valores mayores en los tumores biológicamente más agresivos. No se observaron diferencias con respecto al índice N/T. El análisis de Kaplan–Meier reveló que las categorías de riesgo se relacionaron de forma significativa con la SG y SLE. En el análisis multivariante, el estadio metabólico y la categoría de riesgo mostraron asociación significativa con la SLE. Conclusion. La categoría de alto riesgo manifestó un peor pronóstico con respecto a las otras categorías, con mayores valores de SUVmax tanto en el tumor primario como en ganglios linfáticos (AU)

Basal 18F-FDG PET/CT as a predictive biomarker of tumor response for neoadjuvant therapy in breast cancer / 18F-FDG PET/TC basal como biomarcador predictor de respuesta tumoral al tratamiento neoadyuvante en el cáncer de mama

Purpose. To explore the relation between tumor kinetic assessed by 18F-FDG PET and final neoadjuvant chemotherapy (NC) response within a molecular phenotype perspective. Material and Methods. Prospective study included 144 women with breast cancer. All patients underwent a dual-time point 18F-FDG PET/CT previous to NC. The retention index (RI), between SUV-1 and SUV-2 was calculated. Molecular subtypes were re-grouped in low, intermediate and high-risk biological phenotypes. After NC, all residual primary tumor specimens were histopathologically classified in tumor regression grades (TRG) and response groups. The relation between SUV-1, SUV-2 and RI with the TRG and response groups was evaluated in all molecular subtypes and in accordance with the risk categories. Results. Responder's lesions showed significant greater SUVmax compared to non-responders. The RI value did not show any significant relation with response. Attending to molecular phenotypes, statistical differences were observed with greater SUV for responders having high-risk molecular subtypes. Conclusion. Glycolytic tumor characteristics showed a significant correlation with NC response and dependence of risk phenotype (AU)

Objetivo. Estudiar la relación entre la cinética tumoral valorada por 18F-FDG PET y la respuesta final al tratamiento neoadyuvante (TN) bajo la perspectiva del fenotipo molecular. Material y métodos. Estudio prospectivo que incluye 144 mujeres con cáncer de mama. A todas las pacientes se les realizó una 18F-FDG PET/CT de doble fase previa al TN. El índice de retención (IR) entre el SUV-1 y el SUV-2 fue calculado. Los subtipos moleculares se agruparon en bajo, intermedio y alto riesgo. Tras el TN, los especímenes residuales tumorales se clasificaron histológicamente en grados de regresión tumoral (GRT) y grupos de respuesta. La relación entre el SUV-1, SUV-2 y el IR con los GRT y los grupos de respuesta se evaluó para todos los subtipos moleculares y las categorías de riesgo. Resultados. Las lesiones que experimentaron respuesta mostraron mayores valores de SUVmax comparadas con las no respondedoras. El IR no mostró ninguna relación significativa con la respuesta. De acuerdo con los fenotipos moleculares, se observaron diferencias significativas con mayores valores de SUV en los respondedores pertenecientes a los subtipos moleculares de alto riesgo. Conclusión. Las características glucolíticas tumorales mostraron una relación significativa con la respuesta al TN y dependencia del fenotipo de riesgo (AU)

Glycolytic activity in breast cancer using 18F-FDG PET/CT as prognostic predictor: A molecular phenotype approach.

AIM: To explore the relationship between basal (18)F-FDG uptake in breast tumors and survival in patients with breast cancer (BC) using a molecular phenotype approach. MATERIAL AND METHODS: This prospective and multicentre study included 193 women diagnosed with BC. All patients underwent an (18)F-FDG PET/CT prior to treatment. Maximum standardized uptake value (SUVmax) in tumor (T), lymph nodes (N), and the N/T index was obtained in all the cases. Metabolic stage was established. As regards biological prognostic parameters, tumors were classified into molecular sub-types and risk categories. Overall survival (OS) and disease free survival (DFS) were obtained. An analysis was performed on the relationship between semi-quantitative metabolic parameters with molecular phenotypes and risk categories. The effect of molecular sub-type and risk categories in prognosis was analyzed using Kaplan-Meier and univariate and multivariate tests. RESULTS: Statistical differences were found in both SUVT and SUVN, according to the molecular sub-types and risk classifications, with higher semi-quantitative values in more biologically aggressive tumors. No statistical differences were observed with respect to the N/T index. Kaplan-Meier analysis revealed that risk categories were significantly related to DFS and OS. In the multivariate analysis, metabolic stage and risk phenotype showed a significant association with DFS. CONCLUSION: High-risk phenotype category showed a worst prognosis with respect to the other categories with higher SUVmax in primary tumor and lymph nodes.

Basal (18)F-FDG PET/CT as a predictive biomarker of tumor response for neoadjuvant therapy in breast cancer.

PURPOSE: To explore the relation between tumor kinetic assessed by (18)F-FDG PET and final neoadjuvant chemotherapy (NC) response within a molecular phenotype perspective. MATERIAL AND METHODS: Prospective study included 144 women with breast cancer. All patients underwent a dual-time point (18)F-FDG PET/CT previous to NC. The retention index (RI), between SUV-1 and SUV-2 was calculated. Molecular subtypes were re-grouped in low, intermediate and high-risk biological phenotypes. After NC, all residual primary tumor specimens were histopathologically classified in tumor regression grades (TRG) and response groups. The relation between SUV-1, SUV-2 and RI with the TRG and response groups was evaluated in all molecular subtypes and in accordance with the risk categories. RESULTS: Responder's lesions showed significant greater SUVmax compared to non-responders. The RI value did not show any significant relation with response. Attending to molecular phenotypes, statistical differences were observed with greater SUV for responders having high-risk molecular subtypes. CONCLUSION: Glycolytic tumor characteristics showed a significant correlation with NC response and dependence of risk phenotype.

Dual time point 2-deoxy-2-[ 18F]fluoro- d -glucose PET/CT: Nodal staging in locally advanced breast cancer / PET-TC con 2-deoxi-2-[ 18F]fluor- d -glucosa en doble fase: estadificación ganglionar en cáncer de mama localmente avanzado

Aim. To assess dual time point 2-deoxy-2-[18F]fluoro-d-glucose 18FFDG PET-CT accuracy in nodal staging and in detection of extra-axillary involvement.M aterial and methods. Dual time point [18F] FDG PET/CT scan was performed in 75 patients. Visual and semiquantitative assessment of lymph nodes was performed. Semiquantitative measurement of SUV and ROC-analysis were carried out to calculate SUVmax cut-off value with the best diagnostic performance. Axillary and extra-axillary lymph node chains were evaluated.Results. Sensitivity and specificity of visual assessment was 87.3% and 75%, respectively. SUVmax values with the best sensitivity were 0.90 and 0.95 for early and delayed PET, respectively. SUVmax values with the best specificity were 1.95 and 2.75, respectively. Extra-axillary lymph node involvement was detected in 26.7%.Conclusion. FDG PET/CT detected extra-axillary lymph node involvement in one-fourth of the patients. Semiquantitative lymph node analysis did not show any advantage over the visual evaluation (AU)

Objetivo. Valorar la precision diagnóstica de la PET-CT con 2-deoxi-2-[18F]fluor-d-glucosa [18F] FDG en doble fase en la estadificación ganglionar y en la detección de afectación extra-axilar. Material y métodos. Se realizó una [18F] FDG PET-TC en doble fase a 75 pacientes. Se valoraron los ganglios linfáticos de forma visual y semicuantitativa. Se realizaron medidas del SUV y análisis ROC para calcular el valor de SUV max con la mejor precisión diagnóstica. Se evaluaron los niveles axilares y extra-axilares.Resultados. La sensibilidad y especificidad del análisis visual fue del 87.3% y 75% respectivamente. Los valores de SUVmax con la mejor sensibilidad fueron de 0.90 y 0.95 para el PET en fase precoz y tardía respectivamente. Los valores de SUV max con la mejor especificidad fueron de 1.95 y 2.75 respectivamente. Se detectó afectación ganglionar extra-axilar en el 26.7%.Conclusión. La PET-TC con FDG detectó afectación ganglionar extra-axilar en una cuarta parte de las pacientes. El análisis semicuantitativo no pareció aportar ninguna ventaja sobre la valoración visual (AU)

Dual time point 2-deoxy-2-[18F]fluoro-D-glucose PET/CT: nodal staging in locally advanced breast cancer.

AIM: To assess dual time point 2-deoxy-2-[(18)F]fluoro-D-glucose (18)(F)FDG PET-CT accuracy in nodal staging and in detection of extra-axillary involvement. MATERIAL AND METHODS: Dual time point [(18)F] FDG PET/CT scan was performed in 75 patients. Visual and semiquantitative assessment of lymph nodes was performed. Semiquantitative measurement of SUV and ROC-analysis were carried out to calculate SUV(max) cut-off value with the best diagnostic performance. Axillary and extra-axillary lymph node chains were evaluated. RESULTS: Sensitivity and specificity of visual assessment was 87.3% and 75%, respectively. SUV(max) values with the best sensitivity were 0.90 and 0.95 for early and delayed PET, respectively. SUV(max) values with the best specificity were 1.95 and 2.75, respectively. Extra-axillary lymph node involvement was detected in 26.7%. CONCLUSION: FDG PET/CT detected extra-axillary lymph node involvement in one-fourth of the patients. Semiquantitative lymph node analysis did not show any advantage over the visual evaluation.

Invaginación yeyunal por metástasis intestinal de un carcinoma primario pulmonar: aportación de un caso y revisión de la literatura / Jejunum invagination by intestinal metastasis from a primary lung carcinoma: report of a case and review of the literature

Las metástasis intestinales por cáncer de pulmón,son entidades clínicas muy raras, que excepcionalmente,se manifiestan antes que el tumor primario.El diagnóstico se basa en la expresión inmunohistoquímicade diversos tipos de queratinas y marcadoresespecíficos pulmonares como TTF-1. El tratamientose enfocará en el contexto de un cáncer depulmón metastásico, aunque puede requerirse unaresección quirúrgica intestinal en caso de perforación,hemorragia u obstrucción intestinal, como elpresente caso.La supervivencia, en los pocos casos publicadoses escasa, no superando las 20 semanas, a pesar deltratamiento realizado.Presentamos un caso de una invaginación intestinalpor metástasis de un carcinoma anaplásico depulmón

Intestinal metastases from primary lung carcinomaare of rare presentation, and exceptionally, canappear before the primary tumor manifestations.The diagnosis is based on the expression of somecytokeratins and specific lung markers, as TTF-1.Obviously, although focusing on the treatment ofthe metastatic lung cancer, a surgical intestinal resectionin case of perforation, intestinal hemorrhageor obstruction is mandatory, as it happened in thecase we report. According to the few published cases,survival is poor, not surpassing 20 weeks in spiteof treatment. We present a case of intestinal intussusceptioncaused by metastases from a primaryanaplastic carcinoma of the lung