PET/CT-guided biopsies of metabolically active bone lesions: applications and clinical impact

Klaeser, Bernd; Wiskirchen, Jakub; Wartenberg, Jan; Weitzel, Thilo; Schmid, Ralph A.; Mueller, M; Krause, Thomas

doi:10.1007/s00259-010-1524-z

Cited by 65 publications

(38 citation statements)

References 24 publications

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“…This concept of relying on metabolic target lesions ( 18 F-FDG metabolic hot spots within the body) for prognostication resembles in a macroscopic way the principle of immunohistochemical grading (Ki-67 index estimation), in which only the proliferative hot spots within a tumor are chosen to determine the proliferative fraction. Including the most aggressive and probably prognostically relevant lesions in tumor heterogeneity or diverging tumor populations may become of increasing importance in later stages of metastatic disease (10), and thus, whole-body molecular imagingbased surveillance might constitute an advantage over proliferation assessment based on non-PET-guided biopsy (25)(26)(27). The value of 18 F-FDG PET in NENs seems of particular interest during the unresectable metastatic stage, as investigated in our study.…”

Section: Discussionmentioning

confidence: 89%

Prognostic Stratification of Metastatic Gastroenteropancreatic Neuroendocrine Neoplasms by ¹⁸F-FDG PET: Feasibility of a Metabolic Grading System

et al. 2014

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The tumor proliferation marker, Ki-67 index, is a well-established prognostic marker in gastroenteropancreatic neuroendocrine neoplasms (NENs). Noninvasive molecular imaging allows whole-body metabolic characterization of metastatic disease. We investigated the prognostic impact of 18 F-FDG PET in inoperable multifocal disease. Methods: Retrospective, dual-center analysis was performed on 89 patients with histologically confirmed, inoperable metastatic gastroenteropancreatic NENs undergoing 18 F-FDG PET/CT within the staging routine. Metabolic (PET-based) grading was in accordance with the most prominent 18 F-FDG uptake (reference tumor lesion): mG1, tumor-to-liver ratio of maximum standardized uptake value # 1.0; mG2, 1.0-2.3; mG3, .2.3. Other potential variables influencing overall survival, including age, tumor origin, performance status, tumor burden, plasma chromogranin A ($600 μg/L), neuronspecific enolase ($25 μg/L), and classic grading (Ki-67-based) underwent univariate (log-rank test) and multivariate analysis (Cox proportional hazards model), with a P value of less than 0.05 considered significant. Results: The median follow-up period was 38 mo (95% confidence interval [CI], 27-49 mo); median overall survival of the 89 patients left for multivariate analysis was 29 mo (95% CI, 21-37 mo). According to metabolic grading, 9 patients (10.2%) had mG1 tumors, 22 (25.0%) mG2, and 57 (64.8%) mG3. On multivariate analysis, markedly elevated plasma neuron-specific enolase (P 5 0.016; hazard ratio, 2.9; 95% CI, 1.2-7.0) and high metabolic grade (P 5 0.015; hazard ratio, 4.7; 95% CI, 1.2-7.0) were independent predictors of survival. Conclusion: This study demonstrated the feasibility of prognostic 3-grade stratification of metastatic gastroenteropancreatic NENs by whole-body molecular imaging using 18 F-FDG PET.

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Section: Discussionmentioning

confidence: 89%

Prognostic Stratification of Metastatic Gastroenteropancreatic Neuroendocrine Neoplasms by ¹⁸F-FDG PET: Feasibility of a Metabolic Grading System

et al. 2014

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“…In sarcomas lacking pathognomonic gene fusions, diagnostic differentiation can be extremely challenging, even with the help of modern diagnostic tools including immunohistochemistry and cytogenetics [38–41]. Additionally, tumor heterogeneity and sampling errors can significantly confound the diagnosis.…”

Section: Discussionmentioning

confidence: 99%

DNA Methylation–Based Classifier for Accurate Molecular Diagnosis of Bone Sarcomas

Cooper

et al. 2017

JCO Precision Oncology

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Purpose Pediatric sarcomas provide a unique diagnostic challenge. There is considerable morphologic overlap between entities, increasing the importance of molecular studies in the diagnosis, treatment, and identification of therapeutic targets. We developed and validated a genome-wide DNA methylation based classifier to differentiate between osteosarcoma, Ewing’s sarcoma, and synovial sarcoma. Materials and Methods DNA methylation status of 482,421 CpG sites in 10 Ewing’s sarcoma, 11 synovial sarcoma, and 15 osteosarcoma samples were determined using the Illumina Infinium HumanMethylation450 array. We developed a random forest classifier trained from the 400 most differentially methylated CpG sites within the training set of 36 sarcoma samples. This classifier was validated on data drawn from The Cancer Genome Atlas (TCGA) synovial sarcoma, TARGET Osteosarcoma, and a recently published series of Ewing’s sarcoma. Results Methylation profiling revealed three distinct patterns, each enriched with a single sarcoma subtype. Within the validation cohorts, all samples from TCGA were accurately classified as synovial sarcoma (10/10, sensitivity and specificity 100%), all but one sample from TARGET-OS were classified as osteosarcoma (85/86, sensitivity 98%, specificity 100%) and 14/15 Ewing’s sarcoma samples classified correctly (sensitivity 93%, specificity 100%). The single misclassified osteosarcoma sample demonstrated high EWSR1 and ETV1 expression on RNA-seq although no fusion was found on manual curation of the transcript sequence. Two additional clinical samples, that were difficult to classify by morphology and molecular methods, were classified as osteosarcoma when previously suspected to be a synovial sarcoma and Ewing’s sarcoma on initial diagnosis, respectively. Conclusion Osteosarcoma, synovial sarcoma, and Ewing’s sarcoma have distinct epigenetic profiles. Our validated methylation-based classifier can be used to provide diagnostic assistance when histological and standard techniques are inconclusive.

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“…Although the use of 18 F-FDG PET/CT-guided percutaneous biopsy has been reported in several types of malignant tumour [6, 7], its use for the biopsy of 18 F-FDG-avid metastatic bone lesions has not been reported in patients with advanced lung cancer. The goal of the present study was to evaluate the safety and efficacy of 18 F-FDG PET/CT guided biopsy of 18 F-FDG-avid metastatic bone lesions in patients with advanced lung cancer.…”

Section: Introductionmentioning

confidence: 99%

PET/CT-guided percutaneous biopsy of FDG-avid metastatic bone lesions in patients with advanced lung cancer: a safe and effective technique

Guo

Hao

Chen

et al. 2016

Eur J Nucl Med Mol Imaging

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Purpose 18F-FDG PET/CT should be performed before a diagnostic biopsy site is chosen in patients with a high clinical suspicion of aggressive, advanced tumour. The aim of this study was to evaluate the safety and efficacy of 18F-FDG PET/CT in guiding biopsy of bone metastases in patients with advanced lung cancer.MethodsPET/CT-guided percutaneous core biopsies were performed in 51 consecutive patients with suspected lung cancer and 18F-FDG-avid bone lesions after whole-body 18F-FDG PET/CT scans. Generally, one tissue sample was obtained from each patient. The final diagnoses were established on the basis of the histology results. The histopathological and molecular testing results were systematically evaluated.ResultsA total of 53 samples were obtained for histological examination or molecular testing as a second biopsy was required in two patients in whom the pathological diagnosis was unclear following the first biopsy. The pathological diagnosis and lung cancer classification were confirmed in 48 patients. The epidermal growth factor receptor mutation status was determined in 23 biopsies, and the mutation rate was 30.4 % (7/23). The anaplastic lymphoma kinase mutation status was determined in 19 biopsies, and the mutation rate was 31.6 % (6/19). Two of the 51 biopsies were positive for non-Hodgkin’s lymphoma and one was positive for metastatic renal cell carcinoma. The first-time diagnostic success rate of biopsy was 96.1 % (49/51) and the overall diagnostic success rate and sensitivity were 100 %. All 51 patients were eventually confirmed as having stage IV disease. No serious complications were encountered and the average biopsy time was 30 min.ConclusionPET/CT-guided percutaneous biopsy of 18F-FDG-avid bone metastases is an effective and safe method that yields a high diagnostic success rate in the evaluation of hypermetabolic bone lesions in patients with suspected advanced lung cancer.

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PET/CT-guided biopsies of metabolically active bone lesions: applications and clinical impact

Cited by 65 publications

References 24 publications

Prognostic Stratification of Metastatic Gastroenteropancreatic Neuroendocrine Neoplasms by ¹⁸F-FDG PET: Feasibility of a Metabolic Grading System

Prognostic Stratification of Metastatic Gastroenteropancreatic Neuroendocrine Neoplasms by ¹⁸F-FDG PET: Feasibility of a Metabolic Grading System

DNA Methylation–Based Classifier for Accurate Molecular Diagnosis of Bone Sarcomas

PET/CT-guided percutaneous biopsy of FDG-avid metastatic bone lesions in patients with advanced lung cancer: a safe and effective technique

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PET/CT-guided biopsies of metabolically active bone lesions: applications and clinical impact

Cited by 65 publications

References 24 publications

Prognostic Stratification of Metastatic Gastroenteropancreatic Neuroendocrine Neoplasms by 18F-FDG PET: Feasibility of a Metabolic Grading System

Prognostic Stratification of Metastatic Gastroenteropancreatic Neuroendocrine Neoplasms by 18F-FDG PET: Feasibility of a Metabolic Grading System

DNA Methylation–Based Classifier for Accurate Molecular Diagnosis of Bone Sarcomas

PET/CT-guided percutaneous biopsy of FDG-avid metastatic bone lesions in patients with advanced lung cancer: a safe and effective technique

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Prognostic Stratification of Metastatic Gastroenteropancreatic Neuroendocrine Neoplasms by ¹⁸F-FDG PET: Feasibility of a Metabolic Grading System

Prognostic Stratification of Metastatic Gastroenteropancreatic Neuroendocrine Neoplasms by ¹⁸F-FDG PET: Feasibility of a Metabolic Grading System