Total-body dynamic PET/CT of micro-metastatic lymph node in a patient with lung cancer

e20549 Background: Total body positron emission tomography (PET) of uExplorer enables imaging of highly quantitative parameters beyond the standardized uptake value (SUV). The aim of this prospective study is to assess the dynamic changes of 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) uptake in characterizing tumor heterogeneity of non-small cell lung cancer (NSCLC). Methods: Sixteen NSCLC patients were prospectively enrolled in a prospective study (NCT04654234, GASTO-1067) between September 2020 and December 2020. All patients underwent a dynamic total-body 18F-FDG PET/CT scan before any treatment. The primary lung tumor, metastatic regional lymph node and inflammatory lymph node were manually delineated by a nuclear medicine physician and a radiation oncologist. Total Body PET was acquired between 0 – 60 mins after the injection of FDG from the subject’s feet. We compared lesion heterogeneity and different image-derived PET metrics including the SUV-mean, Patlak-derived influx rate constant (Ki) and distribution volume (DV). Results: The SUV-mean and Ki-mean of primary lung tumor and metastatic lymph node were significantly higher than inflammatory lymph node (p < 0.001), while there was no significantly different of DV(p > 0.05). By the scatter plot of SUV-mean and Ki-mean of primary lung tumor, 9 patients had been separated into high dynamic FDG metabolic (H-DFM) group and 7 in low DFM(L-DFM) group. The SUV-mean(p = 0.0002) and Ki-mean(p = 0.0002) of primary lung tumor were significantly higher in H-DFM group, whereas there is no difference in metastatic lymph node of both group. Interestingly, the SUV-mean and Ki-mean of primary lung tumor were higher than that of metastatic lymph node(p = 0.0002) in H-DFM group. On the contrast, the SUV-mean and Ki-mean of primary lung tumor were lower than that of metastatic lymph node(p = 0.05) in L-DFM group. There is no significant difference of DV-mean among primary lung tumor, metastatic lymph node and inflammatory lymph node in both arms. Conclusions: The results demonstrated that dynamic parameters from total body PET scan has the potential of providing complementary information of tumor heterogeneity in NSCLC than conventional static SUV imaging. The characteristics of H-DFM and L-DFM group could be taken into account for evaluation of further treatment response.

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236 Evaluation of PD-L1 expression in primary lung tumor and metastatic lymph nodes in the presence of immune cells

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-sitc2020.0236 ◽

2020 ◽

Vol 8 (Suppl 3) ◽

pp. A253-A253

Author(s):

Chris Hansis ◽

Xiaomei Wang ◽

Tao Wang ◽

Gerald Feldman

Keyword(s):

Lung Cancer ◽

Squamous Cell Carcinoma ◽

Lymph Node ◽

Tumor Cells ◽

Squamous Cell ◽

Immune Cells ◽

Lymph Node Metastases ◽

Metastatic Lymph Node ◽

Metastatic Lymph ◽

Node Metastases

BackgroundImmunotherapies against programmed death ligand-1 (PD-L1) have been established as an effective treatment for a subset of lung cancer patients. Even though it is critical for a successful therapy to know prevalent PD-L1 expression patterns in all affected tissues, information on matching lymph node metastases and immune cells is particularly limited. The purpose of this study was thus to evaluate comparative PD-L1 expression profiles in those tissues.MethodsFDA-approved IHC assays for PD-L1 (Dako 22C3) were performed on a lung tissue array (LC814A, US Biomax) according to manufacturer’s instructions. Histopathological analysis by H-scoring was performed to determine the rate and intensity of positive tumor and immune cell staining for each of the 80 cores. The H score was calculated as follows: A total of up to 300 cells were assessed, per specimen, at 40x high-power magnification (typically over 7–10 fields). A staining level of 0–3 was then assigned to each cell, to designate the intensity of specific positive membranous-to-cytoplasmic staining. The H score was subsequently calculated as% cells staining at level 1 (x1) +% cells staining at level 2 (x2) +% cells staining at level 3 (x3) = total H score per sample. This resulted in a maximum possible H score of 300.ResultsOf the 16 adenocarcinoma tumor samples with a valid staining, 7 (44%) showed positive PD-L1 staining for tumor cells and 10 (63%) for primary immune cells. Importantly, 9 matching metastatic lymph node samples out of the 16 samples (56%) showed an increased PD-L1 H score compared to primary tumors for both tumor cells and immune cells (figure 1). Of the 15 squamous cell carcinoma samples with a valid staining, 11 (73%) showed detectable PD-L1 expression levels in the primary tumor and 12 (80%) in the primary immune cells, while 7 (47%) and 9 (60%) showed lower scores in matching metastatic lymph node tumor cells and their immune cells, respectively (figure 2). Very low or no expression of PD-L1 was detected in small cell lung cancer, as to be expected from previous studies.Abstract 236 Figure 1PD-L1 Staining in adenocarcinomaAbstract 236 Figure 2PD-L1 Staining in squamous cell carcinomaConclusionsSquamous cell carcinomas and adenocarcinomas display significant heterogeneity with regard to PD-L1 expression in associated lymph node metastases. While the reasons for this frequent discordant PD-L1 expression pattern involving both tumor and immune cells need to be investigated further, our findings may help guide the proper interpretation of PD-L1 companion diagnostic test results and subsequent therapeutic decisions.AcknowledgementsThe views in this Abstract have not been formally disseminated by the U.S. Food and Drug Administration and should not be construed to represent any agency determination or policy.

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Dynamic 18F-FDG Total body PET Imaging as a predictive marker of induction chemo-immunotherapy response in locally advanced non-small cell lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e20551 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e20551-e20551

Author(s):

Hui Liu ◽

Bo Qiu ◽

DaQuan Wang ◽

Xu Zhang ◽

Hui Liu ◽

...

Keyword(s):

Lymph Node ◽

Pet Imaging ◽

Lung Tumor ◽

Metastatic Lymph Node ◽

Locally Advanced ◽

Predictive Marker ◽

Metastatic Lymph ◽

18F Fdg ◽

Primary Lung Tumor ◽

Total Body

e20551 Background: The purpose of this study was to evaluate the efficacy of dynamic 18F-FDG total body PET imaging as a predictive maker of induction chemo-immunotherapy response in locally advanced non-small cell lung cancer(NSCLC) by a prospective study. Methods: Stage IIIA-IIIC NSCLC patients were prospectively enrolled in a prospective total body PETCT study ( NCT04654234, GASTO-1067) and a randomized phase II clinical trial ( NCT04085250) between September 2020 and December 2020. All patients underwent a dynamic total-body 18F-FDG PET/CT scan before any treatment and after 2 cycles of induction chemo-immunotherapy (docetaxel+cisplatin+nivolumab). The primary lung tumor, metastatic regional lymph node and inflammatory lymph node before and after treatment were manually delineated by a nuclear medicine physician and a radiation oncologist. Total Body PET was acquired between 0 – 60 mins after the injection of FDG from the subject’s feet. Patients was separated into high dynamic FDG metabolic (H-DFM) group and low DFM(L-DFM) group by the scatter plot of SUV-mean and Ki-mean of primary lung tumor. We compared lesion heterogeneity and different image-derived PET metrics including the metabolic tumor volume(MTV), SUV total lesion glycolysis(SUV-TLG), Patlak-derived influx rate constant (Ki) TLG (Ki-TLG). Results: Fifteen patients were analyzed, 8 patients was in H-DFM group and 7 in L-DFM group. Patients in H-DFM group had significant decreased levels of MTV(p < 0.001), SUV-TLG(p < 0.001) and Ki-TLG(p < 0.001) both in primary lung tumor and metastatic lymph node by the induction chemo-immuotherapy. However, patients in L-DFM group only had a significant reduction of MTV in primary lung tumor(p < 0.05). There was no significant difference in the MTV of metastatic lymph node(p > 0.5), the SUV-TLG(p > 0.5) and Ki-TLG(p > 0.5) of primary lung tumor and metastatic lymph node, before and after induction chemo-radiotherapy. Conclusions: Patients in H-DFM group had the better treatment response of induction chemo-immunotherapy with significant decreased levels of MTV, SUV-TLG and Ki-TLG. Dynamic 18F-FDG Total body PET Imaging could be regard as a potential predictive marker of induction chemo-immunotherapy response in the setting of LA-NSCLC.

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Number of Lymph Nodes and Metastatic Lymph Node Ratio Are Associated With Survival in Lung Cancer

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2012.01.065 ◽

2012 ◽

Vol 93 (5) ◽

pp. 1614-1620 ◽

Cited By ~ 59

Author(s):

Chukwumere E. Nwogu ◽

Adrienne Groman ◽

Daniel Fahey ◽

Sai Yendamuri ◽

Elisabeth Dexter ◽

...

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Lymph Node Ratio ◽

Metastatic Lymph Node ◽

Metastatic Lymph ◽

Node Ratio

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Personalized siRNA-Nanoparticle Systemic Therapy using Metastatic Lymph Node Specimens Obtained with EBUS-TBNA in Lung Cancer

Molecular Cancer Research ◽

10.1158/1541-7786.mcr-16-0341 ◽

2017 ◽

Vol 16 (1) ◽

pp. 47-57 ◽

Cited By ~ 6

Author(s):

Tatsuya Kato ◽

Daiyoon Lee ◽

Huang Huang ◽

William Cruz ◽

Hideki Ujiie ◽

...

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Systemic Therapy ◽

Metastatic Lymph Node ◽

Metastatic Lymph

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Metastatic Lymph Node Station Number Predicts Survival in Small Cell Lung Cancer

10.1101/2020.09.06.20189191 ◽

2020 ◽

Author(s):

Zhang Han ◽

Jiang Cong ◽

Jin Kaiqi ◽

Zhang Jing ◽

Chen Yan ◽

...

Keyword(s):

Lung Cancer ◽

Lymph Node ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Cox Regression ◽

Metastatic Lymph Node ◽

Small Cell ◽

Small Cell Lung ◽

Cox Regression Analysis ◽

Metastatic Lymph

Purpose: As for pathologic N category, various regrouping strategies have been raised in non small cell lung cancer (NSCLC) but little was done in small cell lung cancer (SCLC). On the basis of the suggestions discussed in NSCLC, we proposed a novel, metastatic lymph node station number (MNSN) based pathologic N parameter and compared its efficacy in predicting survival with pN in SCLC. Methods: We retrospectively analyzed the patients operated and pathologically diagnosed as SCLC in our hospital between 2009 and 2019. Kaplan Meier method and Cox regression analysis were used to compare survival between groups defined by pN and MNSN. Results: From 2009 to 2019, 566 patients received surgery for SCLC and 530 of them were eligible for subsequent analysis, with a median followup time of 21 months. The 5-year overall survival (OS) rates were 58.8%, 38.6%, 27.9% for pN0, pN1, pN2 stages and were 58.8%, 36.8%, 22.1%, 0% for MNSN0, 1-2, 3-5, 6-7 groups, respectively. Analyses of overall and recurrence-free survival (RFS) revealed that pN1 could not be distinguished from pN2 (OS, p=0.099; RFS, p=0.254), but the groups in MNSN were well separated from each other (OS, p<0.001, p=0.001, p=0.063; RFS, p<0.001, p=0.026, p=0.01, compared with the former group). When adjusted for sex, age, smoking, tumor purity and T stage, MNSN groups were independent hazard factors for OS and RFS.

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