Voter Andrew F, Amindarolzarbi Alireza, Shen Colette J, Wang Jarey, Kang Hyunseok, Sharma Rajni, Solnes Lilja B, Pomper Martin G, Bishop Justin A, Rowe Steven P, Kiess Ana P
The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA.
Sci Rep. 2025 May 16;15(1):17104. doi: 10.1038/s41598-025-01515-z.
Adenoid cystic carcinoma (ACC) is a rare malignancy of the salivary glands with poor long-term outcomes and with a need for improved imaging and therapeutic options. Prostate-specific membrane antigen (PSMA) expression has been observed in ACC and preliminary studies have demonstrated PET imaging using Ga-functionalized PSMA agents for positron emission tomography (PET). We aimed to assess the extent of PSMA expression in a collection of archival ACC samples and demonstrate the feasibility of using F-DCFPyL for PSMA PET imaging of ACC. PSMA expression levels were assessed in 77 ACC and 11 unaffected parotid gland control samples by immunohistochemistry and quantified by mean H-score. Three patients with metastatic ACC, who had previously undergone local resection, were imaged withF-DCFPyL PSMA PET in a prospective, pilot trial setting. Demographic, oncologic, and treatment history from the PET patient cohort were acquired at the time of imaging. Maximum standardized uptake values (SUV) were obtained from representative presumptive metastatic lesions on the F-DCFPyL scans by manual placement of regions-of-interest. PSMA expression was detected in 52% of archival ACC samples, compared to 18% in the unaffected salivary glands. Moderate or high levels of PSMA expression (H-score > 5) were seen in 37% of samples. Radiotracer avid disease was identified on PET imaging of all three patients with tumor SUV values of 4.1, 4.0, and 2.0, corresponding to tumor-to-liver ratios of 0.7, 1.0, and 0.4 respectively. We find that PSMA is expressed in a majority of histologic samples from patients with ACC. We also demonstrated the feasibility of F-DCFPyL PSMA-targeted PET imaging in the assessment of ACC. Overall, the tumor uptake on F-DCFPyL PET was modest compared to lesional uptake seen in prostate cancer. Given the potential role of PSMA-targeted agents in the management of ACC, broadening access to PSMA PET through F-18-labeled PSMA PET agents is important. Clinical trials investigating the use of PSMA-targeted radioligand therapies for ACC are underway.
腺样囊性癌（ACC）是一种罕见的唾液腺恶性肿瘤，长期预后较差，需要改进成像和治疗方案。已在ACC中观察到前列腺特异性膜抗原（PSMA）表达，初步研究表明使用镓功能化PSMA剂进行正电子发射断层扫描（PET）的PET成像。我们旨在评估一组存档ACC样本中PSMA表达的程度，并证明使用F-DCFPyL进行ACC的PSMA PET成像的可行性。通过免疫组织化学评估77例ACC和11例未受影响的腮腺对照样本中的PSMA表达水平，并通过平均H评分进行量化。三名先前接受过局部切除的转移性ACC患者在前瞻性试点试验中接受了F-DCFPyL PSMA PET成像。在成像时获取PET患者队列的人口统计学、肿瘤学和治疗史。通过手动放置感兴趣区域，从F-DCFPyL扫描上具有代表性的推定转移病变中获得最大标准化摄取值（SUV）。在52%的存档ACC样本中检测到PSMA表达，而未受影响的唾液腺中为18%。37%的样本中观察到中度或高水平的PSMA表达（H评分>5）。在所有三名患者的PET成像中均发现放射性示踪剂摄取阳性的疾病，肿瘤SUV值分别为4.1、4.0和2.0，对应的肿瘤与肝脏比值分别为0.7、1.0和0.4。我们发现PSMA在大多数ACC患者的组织学样本中表达。我们还证明了F-DCFPyL PSMA靶向PET成像在评估ACC中的可行性。总体而言，与前列腺癌中病变摄取相比，F-DCFPyL PET上的肿瘤摄取适中。鉴于PSMA靶向药物在ACC管理中的潜在作用，通过F-18标记的PSMA PET药物扩大PSMA PET的可及性很重要。正在进行调查PSMA靶向放射性配体疗法用于ACC的临床试验。
