BACKGROUND.This study was designed to investigate the fluorine‐18 fluorodeoxyglucose (FDG)‐positron emission tomography (PET) imaging characteristics of triple‐negative (estrogen receptor‐negative [ER−]/progesterone receptor‐negative [PR−]/HER2‐negative [HER2−]) breast carcinoma and compare the results with characteristics of ER+/PR+/HER2− breast carcinomas, which usually carry a favorable prognosis.METHODS.Patients with newly diagnosed breast carcinoma who had undergone dual‐time‐point FDG‐PET before any therapeutic intervention and were identified as either ER−/PR−/HER2− or ER+/PR+/HER2− (the control group) on histopathology of the surgical specimen, were considered candidates for inclusion in this analysis. These patients underwent FDG‐PET as a component of a prospective study that evaluated the role of multimodality imaging for characterizing primary breast lesions and locoregional staging. Breast cancer lesions were imaged twice at approximately 63 minutes and 101 minutes after the administration of FDG. Maximum standardized uptake values (SUVmax) were measured at both time points (SUVmax1 and SUVmax2) to analyze the data generated. After FDG‐PET imaging, the patients underwent either breast‐conserving surgery or mastectomy, and histopathology reports were used to provide the definitive diagnosis against which the PET study results were compared.RESULTS.In total, 88 patients with breast cancer (29 patients with ‘triple‐negative’ breast cancer and 59 patients with ER+/PR+/HER2− breast malignancies) were selected among 206 individuals who were enrolled in the study protocol. The ‘triple‐negative’ group comprised 14.08% of the total study population. The age of the patients with this subtype of tumor ranged from 33 years to 75 years (mean age±standard deviation, 51.6 ± 10.1 years), and tumors in this subgroup ranged in size from 0.9 cm to 6 cm (mean size, 1.99 cm). Among the histopathologic subtypes, 25 tumors were infiltrating ductal carcinoma (86%), and 1 tumor each (3.5% each subtype) was lobular, mixed ductal‐lobular, medullary, and tubular. For the calculation of FDG‐PET parameters in this group, only patients who had undergone FDG‐PET studies before any intervention were considered, and 18 patients in the triple‐negative group met this criterion. According to same criterion, a control group of 59 patients with ER+/PR+/HER2− cancer who had focal FDG uptake were selected for comparison with the triple‐negative population. The breast cancer lesions were observed as areas with focally enhanced uptake of FDG in all patients (sensitivity, 100%) in the triple‐negative group. The mean (±standard deviation) SUVmax1 of the primary lesion for the triple‐negative group was 7.27 ± 5.6, the mean SUVmax2 was 8.29 ± 6.4, and the percentage change in SUVmax (%ΔSUVmax) was 14.3 ± 15.8%. In the control group of 59 patients with ER+/PR+/HER2− breast carcinoma, the mean values for SUVmax1, SUVmax2, and %ΔSUVmax were 2.68 ± 1.9, 2.84 ± 2.2, and 3.7 ± 13.0%, respectively. The mean values for SUVmax1, SUVmax2, and %Dgr;SUVmax in the triple‐negative group were significantly higher compared with the values in the nontriple‐negative control group (P = .0032, P = .002, and P = .017, respectively). When the 2 subgroups were compared according to tumor size, grade, and stage, the SUVmax1 was significantly higher in the triple‐negative group for both size categories (5.4 vs 1.9, P = .006; and 9.2 vs 3.5, P = .04) and for grade 3 tumors (9.1 vs 3.9, P = .022). The %ΔSUVmax values for patients in the triple‐negative group who had tumors that measured ≤2 cm and > 2 cm were 14.8 and 13.8, respectively; and the corresponding values for patients in the control group were 0.6 and 6.7, respectively. Although the mean %ΔSUVmax clearly was higher in the triple‐negative group for both tumor size categories, comparison between the 2 groups demonstrated a statistically significant difference in tumors that measured ≤2 cm (P = .016). The authors also observed that, in the triple‐negative group, tumor grades were correlated significantly with the magnitude of SUVmax1 and SUVmax2 (P = .012 and P = .01, respectively). Stage for stage, tumors from the triple‐negative group appeared to have a higher mean SUVmax1 compared with tumors from nontriple‐negative control group. However, the trend reached statistical significance in patients with stage II disease.CONCLUSIONS.Triple‐negative breast tumors were associated with enhanced FDG uptake commensurate with their aggressive biology and were detected with very high sensitivity by using FDG‐PET imaging. Cancer 2008. © 2007 American Cancer Society.

Introduction and Aim: Cancer-associated fibroblasts, which are densely found in tumor tissue, express high levels of fibroblast activation protein (FAP), and FAP inhibitors (FAPIs) labeled with radionuclides can be used in the diagnosis and treatment of cancer. In this study, the role of 68 Ga-DOTA-FAPI-04 PET/CT in imaging of primary, metastatic, and recurrent cancers was investigated. Patients and Methods: A total of 42 patients (16 females, 26 males; mean age, 58.5 years; range, 31-84 years) with 22 different types of malignant diseases were included in the study. 68 Ga-DOTA-FAPI-04 PET/CT imaging was performed 1 to 7 days after 18 F-FDG PET/CT. Pathological uptake levels in primary tumoral lesions, lymph nodes, skeletal system, liver, peritoneal surfaces, and other body parts were compared between 2 PET/CTs. In addition, physiological uptake levels of 18 F-FDG and 68 Ga-FAPI were defined measuring the liver, thoracic aorta, gluteal muscle activities, and uterus activity in female patients. Results: Of the 42 patients in the study group, 33 patients were included for staging, 8 patients for restaging, and 1 patient for evaluation of treatment response. 68 Ga-DOTA-FAPI-04 PET/CT showed intense uptake in 94.2% of primary tumoral lesions. In patients with multiple myeloma, 18 F-FDG uptake in the bone marrow was significantly higher than 68 Ga-FAPI uptake, whereas in gastric signet ring cell tumors, 68 Ga-FAPI uptake was found to be significantly higher than 18 F-FDG uptake. It was observed that 68 Ga-DOTA-FAPI-04 PET/CT detected bone, liver, and peritoneum metastases with higher sensitivity and accuracy compared 18 F-FDG PET/CT. Conclusions: The preliminary findings of this study showed that 68 Ga-DOTA-FAPI-04 PET/CT can contribute to the diagnostic process in solid tumors. Especially in malignancies with mild uptake on 18 F-FDG PET/CT, it stands out in diagnosis, staging, and restaging. It is also predicted that FAPI molecules can be used for radionuclide therapy in patients with metastatic disease and unresponsive to other treatments showing intense uptake on 68 Ga-DOTA-FAPI-04 PET/CT.

Background: Conventional imaging modalities are inadequate to evaluate locoregional extension of prostate cancer (PCa). The aim of the current retrospective study was to investigate the diagnostic efficacy of Gallium-68 prostate-specific membrane antigen-11 (Ga-68 PSMA-11) positron emission tomography/computed tomography (PET/CT) and multiparametric magnetic resonance imaging (mp-MRI) for staging preoperative PCa patients with correlating histopathology. Materials and Methods:Twenty-four patients with histologically proven PCa underwent both Ga-68 PSMA-11 PET/CT and mp-MRI before robot-assisted laparoscopic radical prostatectomy. For each tumor area, correlations with histopathological results were defined for tumor localization, extraprostatic extension (EPE) of the tumor, invasion of seminal vesicle (SVI) and bladder neck invasion (BNI). In patients with regional lymph node (LN) dissection, histopathological results were also correlated with imaging modalities.Results: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for detection of EPE and SVI were higher for mp-MRI than Ga-68 PSMA-11 PET/CT. On the other hand Ga-68 PSMA-11 PET/CT had significant successful results for detection of LN metastases when compared with mp-MRI. But for BNI detection both modalities had same insufficient results. Ga-68 PSMA-11 PET/ CT had strong results for appropriate tumor localization in the gland. Conclusion: Ga-68 PSMA PET/CT has superior results for assessing local LN metastases and for intraprostatic tumor localization. Whereas, mp-MRI must be the preferred modality for determining SVI and EPE. But both imaging modalities failed for determining BNI accurately. Both modalities should be used in conjunction with each other for better treatment planning. K E Y W O R D S extraprostatic extension, Gallium-68 prostate-specific membrane antigen-11 positron emission tomography/computed tomography, lymph node, multiparametric magnetic resonance imaging, prostate cancer, seminal vesicle The Prostate. 2019;79:1007-1017. wileyonlinelibrary.com/journal/pros

FDG PET was able to identify extra-axillary regional nodal and distant lesions in newly diagnosed patients with breast cancer; FDG PET may alter the staging and management of therapy in patients with newly diagnosed breast cancer.

The purpose of this prospective study was to investigate whether correlations exist between 18 F-FDG uptake of primary breast cancer lesions and predictive and prognostic factors such as estrogen receptor (ER), progesterone receptor (PR), and C-erbB-2 receptor (C-erbB-2R) states. Methods: Before undergoing partial or total mastectomy, 213 patients with newly diagnosed breast cancer underwent 18 F-FDG PET (5.2 MBq/kg of body weight). The maximum standardized uptake value (SUV) of the primary lesion was measured in each patient. Standard immunohistochemistry was performed on a surgical specimen of the cancer lesion to characterize the receptor state of the tumor cells. Pearson x 2 tests were performed on the cross-tables of different receptor states to test any association that may exist among ER, PR, and C-erbB-2R. Maximum SUV measurements for different receptor states were compared using factorial ANOVA in a completely random design. Results: After exclusion of certain lesions, 118 lesions were analyzed for this study. The mean maximum SUVs of ER-positive and ER-negative lesions were 3.03 6 0.26 and 5.64 6 0.75, whereas those of PR were 3.24 6 0.29 and 4.89 6 0.67, respectively, and those of C-erbB-2R were 4.64 6 0.70 and 3.70 6 0.35, respectively. x 2 tests for ER and PR showed that if one is positive then the other tends to be positive as well (x 2 5 71.054, P , 0.01). For ER and C-erbB-2R states, if ER is positive, C-erbB-2R will more likely be negative (x 2 5 13.026, P , 0.01). No relationship was detected between PR and C-erbB-2R states (x 2 5 3.695, P . 0.05). ANOVAs showed that PR state alone (F 5 0.095, P . 0.05) and C-erbB-2R state alone (F 5 0.097, P . 0.05) had no effect on 18 F-FDG uptake but ER state alone had an effect (F 5 9.126, P , 0.01). ER and PR being together had no additional effect on 18 F-FDG uptake. Our study also demonstrated that interactions exist between ER and C-erbB-2R state and between PR and C-erbB-2R state. Conclusion: SUV measurements may provide valuable information about the state of ER, PR, and C-erbB-2R and the associated glucose metabolism as measured by 18 F-FDG uptake of the primary breast cancer lesions. Such an association may be of importance to treatment planning and outcome in these patients.

There is an increasing uptake of (18)F-FDG over time in pleural malignancies, whereas the uptake in benign pleural disease generally stays stable or decreases over time. Therefore, dual time point imaging appears to be an effective approach in differentiating benign from malignant pleural disease, which increases the sensitivity and is also helpful in guiding the biopsy site for a successful diagnosis.

Introduction Prostate-specific membrane antigen (PSMA) ligand PET/CT is an emerging modality to detect the metastatic disease, especially in intermediate- and high-risk prostate cancer (PCa). In this study, we analyzed the contribution of 68Ga-PSMA-11 PET/CT in staging and therapy management of newly diagnosed PCa. Materials and Methods A total of 78 patients with biopsy-proven PCa who were referred for 68Ga-PSMA-11 PET/CT for primary staging were retrospectively analyzed. The patients were divided into risk groups according to the D'Amico risk stratification criteria. All of the patients had undergone pelvic MRI, and 65 patients had bone scintigraphy also. The findings of 68Ga-PSMA-11 PET/CT were compared with these conventional imaging (CI) methods for staging of the disease. The relations between SUVmax of the primary tumors and Gleason scores (GSs), prostate-specific antigen (PSA) levels, and metastatic extent of the disease were analyzed. Results Of 78 patients, 5 patients were in low-risk group, 18 patients were in intermediate-risk group, and 55 patients were in high-risk group. Metastatic disease was found in 40 (51.2%) of 78 patients in 68Ga-PSMA-11 PET/CT. Ten patients had regional lymph node metastases, and 30 patients had distant metastases. 68Ga-PSMA-11 PET/CT changed the staging in 44 (56.4%) of 78 patients compared with CI. There was significant difference between the SUVmax of the tumors with GSs of 6 and 7 compared with GSs of 8, 9, and 10 (P = 0.003). The SUVmax were significantly different between the patients with no metastasis (n = 38) and patients with regional lymph node metastases or distant metastases (n = 40; 16.1 ± 10.9, 28.7 ± 25.8, P = 0.003, respectively). There was significant difference between the SUVmax of patients with PSA level less than 10 ng/mL compared with patients with PSA level of 10 or greater and less than 20 ng/mL and PSA 20 ng/mL or greater (P = 0.009). A weak correlation between PSA and primary tumor SUVmax was also found (r = 0.21). Conclusions 68Ga-PSMA-11 PET/CT is an important imaging modality for primary evaluation of newly diagnosed PCa changing the disease stage substantially. Also the SUVmax of the primary tumor has a relation with GS, metastatic extent of disease, and PSA levels defining the prognosis.

Increased primary tumor F-FDG uptake was associated with aggressive molecular subtypes in this study. The relationship of distant nodal and organ metastasis with primary tumor SUVmax showed that increased F-FDG uptake is important in terms of management of therapy and prognosis.