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The Role of PET Imaging in Oncology: New Advancements in Clinical and Research Setting

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A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: closed (31 March 2024) | Viewed by 11119

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Special Issue Editors

Dr. Pierpaolo Alongi

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Guest Editor

Nuclear Medicine Unit, A.R.N.A.S. Ospedale Civico Di Cristina Benfratelli, 90127 Palermo, Italy
Interests: PET/CT; PET/MRI; oncology; prostate cancer; gliomas
Special Issues, Collections and Topics in MDPI journals

Dr. Desiree Deandreis

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Guest Editor

Department of Medical Sciences, Division of Nuclear Medicine, University of Turin, AOU Città della Salute e della Scienza, Turin, Italy
Interests: PET/CT; oncology; thyroid cancer; endocrine tumors; theranostic

Special Issue Information

Dear Colleagues,

PET imaging has become the most relevant diagnostic tool in the oncology field. Several radiopharmaceuticals have been progressively evaluated in the clinical scenario for different diseases. In the last 15 years, 18F-FDG PET/CT revolutionized staging and restaging in the most aggressive neoplasms, with particular regard for the early assessment of recurrent metastatic disease and response to therapy evaluation. The advent of precision therapy conferred PET imaging a crucial role in clinical management. Other radiotracers, such as 68Ga-Dotatatoc/tate/noc and 68Ga/18F-PSMA, have demonstrated high accuracy for neuroendocrine and prostate tumors, respectively, also opening a new era of functional imaging guiding radioligand therapy (theragnostics).

New technological and radiopharmaceutical developments are currently the objective of future research. This Special Issue will focus on new advancements of PET imaging in oncology (PET/CT, PET/MRI) in clinical and research settings, also evaluating the novel application of artificial intelligence.

We invite authors to submit contributions that provide novel findings or reviews that comprehensively highlight the latest discoveries in the field.

Dr. Pierpaolo Alongi
Dr. Desiree Deandreis
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

PET/CT
PET/MRI
oncology
theragnostic
radiopharmaceuticals

Published Papers (7 papers)

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Research

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14 pages, 1681 KiB

Open AccessArticle

The Diagnostic and Predictive Value of ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Laryngeal Squamous Cell Carcinoma

by Akram Al-Ibraheem, Ahmed Saad Abdlkadir, Qaid Ahmed Shagera, Omar Saraireh, Dhuha Al-Adhami, Rakan Al-Rashdan, Farah Anwar, Serin Moghrabi, Issa Mohamad, Kristoff Muylle, Enrique Estrada, Diana Paez, Asem Mansour and Egesta Lopci

Cancers 2023, 15(22), 5461; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15225461 - 17 Nov 2023

Cited by 1 | Viewed by 1175

Abstract

This retrospective study examines the diagnostic accuracy of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) and neck magnetic resonance imaging (MRI) in detecting nodal metastasis for patients with laryngeal squamous cell carcinoma (LSCC) and assesses the predictive values of metabolic and structural features derived from ¹⁸F-FDG PET/CT. By involving 66 patients from 2014 to 2021, the sensitivity and specificity of both modalities were calculated. ¹⁸F-FDG PET/CT outperforms neck MRI for nodal disease detection, with 89% sensitivity, 65% specificity, and 77% accuracy for nodal metastasis (p = 0.03). On the other hand, neck MRI had 66% sensitivity, 62% specificity, and 64% accuracy. Approximately 11% of patients witnessed a change in their therapy intent when relying on ¹⁸F-FDG PET/CT nodal staging results. Analyzing the cohort for PET-derived metabolic and morphological parameters, a total of 167 lymph nodes (LN) were visualized. Parameters such as the LN maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and LN size were computed. Logistic regression and receiver operating characteristic (ROC) analyses were performed. Among the 167 identified cervical LNs, 111 were histopathologically confirmed as positive. ROC analysis revealed the highest area under the curve for LN MTV (0.89; p < 0.01), followed by LN size (0.87; p < 0.01). Both MTV and LN size independently predicted LN metastasis through multivariate analysis. In addition, LN MTV can reliably predict false-positive LNs in preoperative staging, offering a promising imaging-based approach for further exploration. Full article

(This article belongs to the Special Issue The Role of PET Imaging in Oncology: New Advancements in Clinical and Research Setting)

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10 pages, 1340 KiB

Open AccessArticle

¹⁸F-FDG PET-Derived Volume-Based Parameters to Predict Disease-Free Survival in Patients with Grade III Breast Cancer of Different Molecular Subtypes Candidates to Neoadjuvant Chemotherapy

by Natale Quartuccio, Pierpaolo Alongi, Luca Urso, Naima Ortolan, Francesca Borgia, Mirco Bartolomei, Gaspare Arnone and Laura Evangelista

Cancers 2023, 15(10), 2715; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15102715 - 11 May 2023

Cited by 2 | Viewed by 1222

Abstract

We investigated whether baseline [¹⁸F] Fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET)-derived semiquantitative parameters could predict disease-free survival (DFS) in patients with grade III breast cancer (BC) of different molecular subtypes candidate to neoadjuvant chemotherapy (NAC). For each ¹⁸F-FDG-PET/CT scan, the following parameters were calculated in the primary tumor (SUVmax, SUVmean, MTV, TLG) and whole-body (WB_SUVmax, WB_MTV, and WB_TLG). Receiver operating characteristic (ROC) analysis was used to determine the capability to predict DFS and find the optimal threshold for each parameter. Ninety-five grade III breast cancer patients with different molecular types were retrieved from the databases of the University Hospital of Padua and the University Hospital of Ferrara (luminal A: 5; luminal B: 34; luminal B-HER2: 22; HER2-enriched: 7; triple-negative: 27). In luminal B patients, WB_MTV (AUC: 0.75; best cut-off: WB_MTV > 195.33; SS: 55.56%, SP: 100%; p = 0.002) and WB_TLG (AUC: 0.73; best cut-off: WB_TLG > 1066.21; SS: 55.56%, SP: 100%; p = 0.05) were the best predictors of DFS. In luminal B-HER2 patients, WB_SUVmax was the only predictor of DFS (AUC: 0.857; best cut-off: WB_SUVmax > 13.12; SS: 100%; SP: 71.43%; p < 0.001). No parameter significantly affected the prediction of DFS in patients with grade III triple-negative BC. Volume-based parameters, extracted from baseline ¹⁸F-FDG PET, seem promising in predicting recurrence in patients with grade III luminal B and luminal B- HER2 breast cancer undergoing NAC. Full article

(This article belongs to the Special Issue The Role of PET Imaging in Oncology: New Advancements in Clinical and Research Setting)

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16 pages, 1669 KiB

Open AccessArticle

Characterization of Mediastinal Bulky Lymphomas with FDG-PET-Based Radiomics and Machine Learning Techniques

by Elisabetta Maria Abenavoli, Matteo Barbetti, Flavia Linguanti, Francesco Mungai, Luca Nassi, Benedetta Puccini, Ilaria Romano, Benedetta Sordi, Raffaella Santi, Alessandro Passeri, Roberto Sciagrà, Cinzia Talamonti, Angelina Cistaro, Alessandro Maria Vannucchi and Valentina Berti

Cancers 2023, 15(7), 1931; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15071931 - 23 Mar 2023

Cited by 4 | Viewed by 1580

Abstract

Background: This study tested the diagnostic value of 18F-FDG PET/CT (FDG-PET) volumetric and texture parameters in the histological differentiation of mediastinal bulky disease due to classical Hodgkin lymphoma (cHL), primary mediastinal B-cell lymphoma (PMBCL) and grey zone lymphoma (GZL), using machine learning techniques. Methods: We reviewed 80 cHL, 29 PMBCL and 8 GZL adult patients with mediastinal bulky disease and histopathological diagnoses who underwent FDG-PET pre-treatment. Volumetric and radiomic parameters were measured using FDG-PET both for bulky lesions (BL) and for all lesions (AL) using LIFEx software (threshold SUV ≥ 2.5). Binary and multiclass classifications were performed with various machine learning techniques fed by a relevant subset of radiomic features. Results: The analysis showed significant differences between the lymphoma groups in terms of SUVmax, SUVmean, MTV, TLG and several textural features of both first- and second-order grey level. Among machine learning classifiers, the tree-based ensembles achieved the best performance both for binary and multiclass classifications in histological differentiation. Conclusions: Our results support the value of metabolic heterogeneity as an imaging biomarker, and the use of radiomic features for early characterization of mediastinal bulky lymphoma. Full article

(This article belongs to the Special Issue The Role of PET Imaging in Oncology: New Advancements in Clinical and Research Setting)

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9 pages, 736 KiB

Open AccessArticle

Qualitative and Semiquantitative Parameters of ¹⁸F-FDG-PET/CT as Predictors of Malignancy in Patients with Solitary Pulmonary Nodule

by Ferdinando Corica, Maria Silvia De Feo, Maria Lina Stazza, Maria Rondini, Andrea Marongiu, Viviana Frantellizzi, Susanna Nuvoli, Alessio Farcomeni, Giuseppe De Vincentis and Angela Spanu

Cancers 2023, 15(4), 1000; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15041000 - 04 Feb 2023

Cited by 1 | Viewed by 1314

Abstract

This study aims to evaluate the reliability of qualitative and semiquantitative parameters of ¹⁸F-FDG PET-CT, and eventually a correlation between them, in predicting the risk of malignancy in patients with solitary pulmonary nodules (SPNs) before the diagnosis of lung cancer. A total of 146 patients were retrospectively studied according to their pre-test probability of malignancy (all patients were intermediate risk), based on radiological features and risk factors, and qualitative and semiquantitative parameters, such as SUVmax, SUVmean, TLG, and MTV, which were obtained from the FDG PET-CT scan of such patients before diagnosis. It has been observed that visual analysis correlates well with the risk of malignancy in patients with SPN; indeed, only 20% of SPNs in which FDG uptake was low or absent were found to be malignant at the cytopathological examination, while 45.45% of SPNs in which FDG uptake was moderate and 90.24% in which FDG uptake was intense were found to be malignant. The same trend was observed evaluating semiquantitative parameters, since increasing values of SUVmax, SUVmean, TLG, and MTV were observed in patients whose cytopathological examination of SPN showed the presence of lung cancer. In particular, in patients whose SPN was neoplastic, we observed a median (MAD) SUVmax of 7.89 (±2.24), median (MAD) SUVmean of 3.76 (±2.59), median (MAD) TLG of 16.36 (±15.87), and a median (MAD) MTV of 3.39 (±2.86). In contrast, in patients whose SPN was non-neoplastic, the SUVmax was 2.24 (±1.73), SUVmean 1.67 (±1.15), TLG 1.63 (±2.33), and MTV 1.20 (±1.20). Optimal cut-offs were drawn for semiquantitative parameters considered predictors of malignancy. Nodule size correlated significantly with FDG uptake intensity and with SUVmax. Finally, age and nodule size proved significant predictors of malignancy. In conclusion, considering the pre-test probability of malignancy, qualitative and semiquantitative parameters can be considered reliable tools in patients with SPN, since cut-offs for SUVmax, SUVmean, TLG, and MTV showed good sensitivity and specificity in predicting malignancy. Full article

(This article belongs to the Special Issue The Role of PET Imaging in Oncology: New Advancements in Clinical and Research Setting)

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17 pages, 3531 KiB

Open AccessArticle

Role of Machine Learning (ML)-Based Classification Using Conventional ¹⁸F-FDG PET Parameters in Predicting Postsurgical Features of Endometrial Cancer Aggressiveness

by Carolina Bezzi, Alice Bergamini, Gregory Mathoux, Samuele Ghezzo, Lavinia Monaco, Giorgio Candotti, Federico Fallanca, Ana Maria Samanes Gajate, Emanuela Rabaiotti, Raffaella Cioffi, Luca Bocciolone, Luigi Gianolli, GianLuca Taccagni, Massimo Candiani, Giorgia Mangili, Paola Mapelli and Maria Picchio

Cancers 2023, 15(1), 325; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15010325 - 03 Jan 2023

Cited by 3 | Viewed by 2386

Abstract

Purpose: to investigate the preoperative role of ML-based classification using conventional ¹⁸F-FDG PET parameters and clinical data in predicting features of EC aggressiveness. Methods: retrospective study, including 123 EC patients who underwent ¹⁸F-FDG PET (2009–2021) for preoperative staging. Maximum standardized uptake value (SUVmax), SUVmean, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were computed on the primary tumour. Age and BMI were collected. Histotype, myometrial invasion (MI), risk group, lymph-nodal involvement (LN), and p53 expression were retrieved from histology. The population was split into a train and a validation set (80–20%). The train set was used to select relevant parameters (Mann-Whitney U test; ROC analysis) and implement ML models, while the validation set was used to test prediction abilities. Results: on the validation set, the best accuracies obtained with individual parameters and ML were: 61% (TLG) and 87% (ML) for MI; 71% (SUVmax) and 79% (ML) for risk groups; 72% (TLG) and 83% (ML) for LN; 45% (SUVmax; SUVmean) and 73% (ML) for p53 expression. Conclusions: ML-based classification using conventional ¹⁸F-FDG PET parameters and clinical data demonstrated ability to characterize the investigated features of EC aggressiveness, providing a non-invasive way to support preoperative stratification of EC patients. Full article

(This article belongs to the Special Issue The Role of PET Imaging in Oncology: New Advancements in Clinical and Research Setting)

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12 pages, 2075 KiB

Open AccessArticle

The Value of Semiquantitative Parameters Derived from ¹⁸F-FDG PET/CT for Predicting Response to Neoadjuvant Chemotherapy in a Cohort of Patients with Different Molecular Subtypes of Breast Cancer

by Luca Urso, Laura Evangelista, Pierpaolo Alongi, Natale Quartuccio, Corrado Cittanti, Ilaria Rambaldi, Naima Ortolan, Francesca Borgia, Alberto Nieri, Licia Uccelli, Alessio Schirone, Stefano Panareo, Gaspare Arnone and Mirco Bartolomei

Cancers 2022, 14(23), 5869; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14235869 - 29 Nov 2022

Cited by 7 | Viewed by 1511

Abstract

Pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) is a strong prognostic factor in breast cancer (BC). The aim of this study was to investigate whether semiquantitative parameters derived from baseline [¹⁸F]Fluorodeoxyglucose ([¹⁸F]FDG) positron emission computed tomography/computed tomography (PET/CT) could predict pCR after NAC and survival outcomes in patients affected by different molecular subtypes of BC. We retrospectively retrieved patients from the databases of two Italian hospitals (Centre A: University Hospital of Ferrara; Centre B: University of Padua) meeting the following inclusion criteria: (1) diagnosis of BC; (2) history of NAC; (3) baseline [¹⁸F]FDG PET/CT performed before the first cycle of NAC; (4) available follow-up data (response after NAC and survival information). For each [¹⁸F]FDG PET/CT scan, semiquantitative parameters (SUVmax, SUVmean, MTV and TLG) related to the primary tumor (B), to the reference lesion for both axillary (N) and distant lymph node (DN), and to the whole-body burden of disease (WB) were evaluated. Patients enrolled were 133: 34 from centre A and 99 from centre B. Patients’ molecular subtypes were: 9 luminal A, 49 luminal B, 33 luminal B + HER-2, 10 HER-2 enriched, and 32 triple negative (TNBC). Luminal A and HER-2 enriched BC patients were excluded from the analysis due to the small sample size. pCR after NAC was achieved in 47 patients (41.2%). [¹⁸F]FDG PET/CT detected the primary tumor in 98.3% of patients and lymph node metastases were more frequently detected in Luminal B subgroup. Among Luminal B patients, median SUVmean_B values were significantly higher (p = 0.027) in responders (7.06 ± 5.9) vs. non-responders (4.4 ± 2.1) to NAC. Luminal B + HER-2 non-responders showed a statistically significantly higher median MTV_B (7.3 ± 4.2 cm³ vs. 3.5 ± 2.5 cm³; p = 0.003) and TLG_B (36.5 ± 24.9 vs. 18.9 ± 17.7; p = 0.025) than responders at baseline [¹⁸F]FDG PET/CT. None of the semiquantitative parameters predicted pCR after NAC in TNBC patients. However, among TNBC patients who achieved pCR after NAC, 4 volumetric parameters (MTV_B, TLG_B, MTV_WB and TLG_WB) were significantly higher in patients dead at follow-up. If confirmed in further studies, these results could open up a widespread use of [¹⁸F]FDG PET/CT as a baseline predictor of response to NAC in luminal B and luminal B + HER-2 patients and as a prognostic tool in TNBC. Full article

(This article belongs to the Special Issue The Role of PET Imaging in Oncology: New Advancements in Clinical and Research Setting)

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16 pages, 630 KiB

Open AccessSystematic Review

FAPi-Based Agents in Thyroid Cancer: A New Step towards Diagnosis and Therapy? A Systematic Review of the Literature

by Priscilla Guglielmo, Pierpaolo Alongi, Lucia Baratto, Miriam Conte, Elisabetta Maria Abenavoli, Ambra Buschiazzo, Greta Celesti, Francesco Dondi, Rossella Filice, Joana Gorica, Lorenzo Jonghi-Lavarini, Riccardo Laudicella, Maria Librando, Flavia Linguanti, Francesco Mattana, Alberto Miceli, Laura Olivari, Leandra Piscopo, Giulia Santo, Fabio Volpe and Laura Evangelista Show full author list Hide full author list

Cancers 2024, 16(4), 839; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers16040839 - 19 Feb 2024

Viewed by 938

Abstract

(1) Background: Thyroid cancer (TC) is often treated with surgery followed by iodine-131. Up to 50% of the instances of TC lose their avidity to ¹³¹I, becoming more aggressive. In this scenario, [¹⁸F]FDG PET/CT imaging is used for evaluating the widespread nature of the disease, despite its low sensitivity and a false negative rate of 8–21.1%. A novel class of PET agents targeting the fibroblast activation protein inhibitor (FAPi) has emerged, studied particularly for their potential application to theranostics. (2) Methods: A search of the literature was performed by two independent authors (P.G. and L.E.) using the PubMed, Scopus, Web of Science, Cochrane Library, and EMBASE databases. The following terms were used: “FAP” or “FAPi” or “Fibroblast activating protein” and “thyroid” or “thyroid cancer”, in different combinations. The included papers were original articles, clinical studies, and case reports in the English language. No time limits were used. Editorials, conference papers, reviews, and preclinical studies were excluded. (3) Results: There were 31 papers that were selected. Some studies reported a low or absent FAPi uptake in TC lesions; others reported promising findings for the detection of metastases. (4) Conclusions: The preliminary results are encouraging. FAPI agents are an alternative to [¹⁸F]FDG and a promising theranostic tool. However, further studies with a larger population are needed. Full article

(This article belongs to the Special Issue The Role of PET Imaging in Oncology: New Advancements in Clinical and Research Setting)

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