Metabolic targeting can improve the efficiency of brain tumor biopsies

Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology

“…Biopsy results can be misleading, because gliomas often have varying degrees of cellularity, mitoses, or necrosis from one region to another; thus, small samples can provide erroneous histologic grade or diagnosis. 85,86 Surgical resection plays an important role in the management of low-grade gliomas. A systematic review showed that gross total resection (GTR) was significantly associated with decreased mortality and lower risk of disease progression up to 10 years after treatment, compared with STR.…”

Choline PET/CT and intraoperative management of primary brain tumors. New insights for contemporary neurosurgery

“…Differently from FET and similarly to FLT, Choline-uptake is dependent on BBB damage and, therefore, it should be preferentially used in HGG. Therefore, several reports about the role of CHO-PET in diagnosis and management of brain tumors have been presented for the primary diagnosis of glioblastoma after intratumoral hemorrhage, or in pediatric astrocytomas [4,5]. However, we consider that CHO-PET could play a relevant role as intra-operative guidance for surgical procedures, and preliminary and interesting papers support our aim.…”

“…More recently, other widespread and easily available radiotracers such as choline (CHO) analogues have demonstrated similar results [5]. Hara and coworkers introduced, in 1997, the use of carbon-11 (11C) CHO as radiotracers for PET imaging [6].…”

“…Their results were really interesting: the coregistration of metabolic imaging allowed identifying areas of high mitotic activity in a suspected low-grade tumor, according to conventional MRI. More recently, in 2020, Villena Martin et al reported two adjunctive cases of multicentric glioblastoma, in which MRI and Cho-PET were performed to define the target of the biopsy in the most CHO-avid area [5]. They used the metabolic information acquired by PET to guide the MRS voxel placement in a tumor region of the suspected highest grade, confirming the value of the co-registration of PET and MRI, loaded into the neuronavigator, as intraoperative guidance, especially in case of multicentric tumors with areas of different paramagnetic contrast enhancement.…”

Imaging and treatment of brain tumors through molecular targeting: Recent clinical advances

“…Owing to the heterogeneous nature of brain tumors, imageguided biopsies based on morphological features may not accurately target the tumor, or precisely sample the most biologically aggressive tumor regions [109][110][111]. PET can provide an in vivo metabolic tumor map to guide tissue collection from the most metabolically active tumor area, allowing improved grading compared to sampling based on morphological or functional information [111,112]. Guiding biopsy or treatment using metabolic changes may identify patients with a more aggressive histological or molecular tumor profile, or a higher risk of recurrence and worse outcome, who may benefit from tailored treatments and stricter imaging follow-up.…”