Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Road, NE, Atlanta, GA, 30322, USA.
Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA.
Eur J Nucl Med Mol Imaging. 2024 Nov;51(13):4073-4082. doi: 10.1007/s00259-024-06830-7. Epub 2024 Jul 8.
To explore the feasibility of imaging amino-acid transport and PSMA molecular pathways in the detection of metastatic breast invasive lobular carcinoma (ILC) and if there is superior detection compared to standard-of-care imaging [computed tomography (CT)/bone scan, or F-FDG positron-emission-tomography (PET)-CT].
20 women with de-novo or suspected metastatic ILC underwent two PET-CT scans with F-fluciclovine and Ga-PSMA-11 on separate days. Uptake per patient and in 3 regions per patient - ipsilateral axillary lymph node (LN), extra-axillary LN (ipsilateral supraclavicular or internal mammary), or distant sites of disease - was compared to standard-of-care imaging (CT/bone scan in 13 patients and F-FDG PET-CT in 7 patients). Results were correlated to a composite standard of truth. Confirmed detection rate (cDR) was compared using McNemar's test. Mean SUVmax of F-fluciclovine and Ga-PSMA-11 in the most avid lesion for each true positive metastatic region and intact primary lesion were compared by t-test.
The cDR for standard-of-care imaging was 5/20 patients in 5/60 regions. Ga-PSMA-11 PET-CT detected metastasis in 7/20 patients in 7/60 regions. F-fluciclovine PET-CT detected metastasis in 9/20 patients in 12/60 regions. The cDR for F-fluciclovine PET-CT was significantly higher versus standard-of-care imaging on the patient and combined region levels, while there were no significant differences between Ga-PSMA-11 and standard-of care imaging. F-fluciclovine cDR was also significantly higher than Ga-PSMA-11 on the combined region level. Mean SUVmax for true positive metastatic and primary lesions with F-fluciclovine (n = 18) was significantly greater than for Ga-PSMA-11 (n = 11) [5.5 ± 1.8 versus 3.5 ± 2.7 respectively, p = 0.021].
In this exploratory trial, F-fluciclovine PET-CT has a significantly higher cDR for ILC metastases compared to standard-of-care imaging and to Ga-PSMA-11. Mean SUVmax for true positive malignancy was significantly higher with F-fluciclovine than for Ga-PSMA-11. Exploratory data from this trial suggests that molecular imaging of amino acid metabolism in patients with ILC deserves further study.
Early phase (I-II) clinical trial (NCT04750473) funded by the National Institutes of Health (R21CA256280).
探讨在检测转移性乳腺浸润性小叶癌（ILC）中成像氨基酸转运和 PSMA 分子途径的可行性，以及与标准护理成像[计算机断层扫描（CT）/骨扫描或 F-FDG 正电子发射断层扫描（PET）-CT]相比是否具有更好的检测效果。
20 名新诊断或疑似转移性 ILC 患者在两天内分别进行两次 F-氟西洛文和 Ga-PSMA-11 的 PET-CT 扫描。每位患者和每位患者的 3 个区域（同侧腋窝淋巴结（LN）、对侧 LN（同侧锁骨上或内乳）或远处疾病部位）的摄取与标准护理成像（13 名患者的 CT/骨扫描和 7 名患者的 F-FDG PET-CT）进行比较。结果与综合标准进行相关性分析。使用 McNemar 检验比较确认检测率（cDR）。通过 t 检验比较每个真正阳性转移性区域和完整原发性病变中最活跃病变的 F-氟西洛文和 Ga-PSMA-11 的平均 SUVmax。
标准护理成像的 cDR 为 5/20 名患者 5/60 个区域。Ga-PSMA-11 PET-CT 在 7/20 名患者的 7/60 个区域中检测到转移。F-氟西洛文 PET-CT 在 9/20 名患者的 12/60 个区域中检测到转移。F-氟西洛文 PET-CT 的 cDR 在患者和联合区域水平上均显著高于标准护理成像，而 Ga-PSMA-11 与标准护理成像之间无显著差异。在联合区域水平上，F-氟西洛文的 cDR 也显著高于 Ga-PSMA-11。F-氟西洛文（n=18）在真正阳性转移和原发性病变中的平均 SUVmax 明显大于 Ga-PSMA-11（n=11）[分别为 5.5±1.8 与 3.5±2.7，p=0.021]。
在这项探索性试验中，F-氟西洛文 PET-CT 对 ILC 转移的 cDR 明显高于标准护理成像和 Ga-PSMA-11。F-氟西洛文在真正的恶性肿瘤中的平均 SUVmax 明显高于 Ga-PSMA-11。该试验的探索性数据表明，对 ILC 患者氨基酸代谢的分子成像值得进一步研究。
由美国国立卫生研究院（R21CA256280）资助的早期阶段（I-II）临床试验（NCT04750473）。
