(18)FDG PET for grading malignancy in thymic epithelial tumors: Significant differences in (18)FDG uptake and expression of glucose transporter-1 and hexokinase II between low and high-risk tumors: Preliminary study

Department of Radiology, Nanpuh Hospital, 14-3 Nagata, Kagoshima 892-8512, Japan.
European journal of radiology (Impact Factor: 2.37). 01/2012; 81(1):146-51. DOI: 10.1016/j.ejrad.2010.08.010
Source: PubMed


To evaluate (18)F-fluorodeoxyglucose (FDG) uptake to predict the malignant nature and analyze the correlation between FDG uptake and expression of glucose transporter 1 (Glut-1) and hexokinase II (HK-II) in thymic epithelial tumors.
Eleven patients with a thymic epithelial tumor who underwent FDG PET/CT before therapy were reviewed. The thymic tumors were classified by the WHO histological classification and Masaoka clinical staging. Comparison of maximum standardized uptake value (SUV(max)) of the lesion was made between the low-risk (Type A, AB and B1) and high-risk {Type B2, B3 and C (thymic cancer)} groups and among clinical stages. Expression of Glut-1 and HK-II was analyzed immunohistochemically.
All 11 tumors showed FDG uptake visually. SUV(max) was significantly higher in the high-risk group (n=5, 5.24 ± 2.44) than the low-risk group (n=6, 3.05 ± 0.55) (P=0.008). Staining scores of both Glut-1 and HK-II were significantly higher in the high-risk group than in the low-risk group (Glut1: P=0.034 and HK-II: P=0.036). There were no significant differences in SUV(max) (P=0.11), Glut-1 (P=0.35) and HK-II scores (P=0.29) among clinical stages. SUV(max) was significantly correlated to each of the staining scores of Glut-1 (ρ=0.68, P=0.031) and HK-II (ρ=0.72, P=0.024).
These preliminary results support the previously published view that SUV(max) may be useful to predict the malignant nature of thymic epitherial tumors and suggest that the degree of FDG uptake in the thymic epitherial tumors is closely related to the amount of Glut-1 and HK-II in the tumor.

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    • "Bertolaccini et al. [21] PET/CT 330–400 MBq 55–70 min T/M SUV, MTV, TGV Seki et al. [36] PET/CT 4–6 MBq/kg 60 min SUVmax Viti et al. [37] PET/CT 330–400 MBq 55–70 min SUVmax, T/M SUV Benveniste et al. [38] PET/CT 333–629 MBq 60–90 min SUVmax, SUVmean, SUVpeak and Total body volumetric SUV De Luca et al. [39] PET/CT 370 MBq 60 min SUVmax Lococo et al. [40] PET/CT 3.7 MBq/kg 60 min SUVmax, SUVmax/tumor size Matsumoto et al. [22] PET or PET/CT 4 MBq/kg 60 min SUVmax Thomas et al. [23] PET/CT 370–555 MBq 60 min SUVmax, T/M SUV Toba et al. [41] PET/CT 3.7 MBq/kg 60 min SUVmax Eguchi et al. [24] PET 5 MBq/kg 60 min SUVmax Fukumoto et al. [42] PET/CT 3.7–4.1 MBq/kg 50 min SUVmax Nakajo et al. [43] PET/CT 3.7 MBq/kg 60 min SUVmax Otsuka et al. [33] PET/CT 3.7 MBq/kg 60 min SUVmax Igai et al. [25] PET 3.5 MBq/kg 60 and 120 min SUVmax Kaira et al. [26] PET or PET/CT 200–250 MBq 60 min T/M SUV Terzi et al. [34] PET/CT 330–400 MBq 55–70 min SUVmax, T/M SUV Kaira et al. [27] PET or PET/CT 200–250 MBq 60 min T/M SUV Inoue et al. [28] PET 370 MBq 60 min and 180 min SUVmax and RI-SUVmax Kumar et al. [44] PET/CT 370 MBq 60 min SUVmax Luzzi et al. [35] "
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    ABSTRACT: Aim To perform a systematic review and meta-analysis of published data on the role of fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in predicting the WHO grade of malignancy in thymic epithelial tumors (TETs). Methods A comprehensive literature search of studies published up to March 2014 was performed. Data on maximum standardized uptake value (SUVmax) in patients with low-risk thymomas (A,AB, B1), high-risk thymomas (B2,B3) and thymic carcinomas (C) according to the WHO classification were collected when reported by the retrieved articles. The comparison of mean SUVmax between low-risk thymomas, high-risk thymomas and thymic carcinomas was expressed as weighted mean difference (WMD) and a pooled WMD was calculated including 95% confidence interval (95%CI). Results Eleven studies were selected for the meta-analysis. The pooled WMD of SUVmax between high-risk and low-risk thymomas was 1.2 (95%CI: 0.4-2.0). The pooled WMD of SUVmax between thymic carcinomas and low-risk thymomas was 4.8 (95%CI: 3.4-6.1). Finally, the pooled WMD of SUVmax between thymic carcinomas and high-risk thymomas was 3.5 (95%CI: 2.7-4.3). Conclusions 18F-FDG PET may predict the WHO grade of malignancy in TETs. In particular, we demonstrated a statistically significant difference of SUVmax between the different TETs (low-grade thymomas, high-grade thymomas and thymic carcinomas).
    Lung Cancer 10/2014; DOI:10.1016/j.lungcan.2014.08.008 · 3.96 Impact Factor
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    • "HIF- 1a is considered to support tumor growth by the FDG-PET in thymic epithelial tumors 199 induction of angiogenesis via the expression of vascular endothelial growth factor (VEGF) and by high and anaerobic metabolic mechanisms [26] . Two papers have reported that the degree of [ 18 F]FDG uptake in thymic epithelial tumors is closely correlated with the amount of Glut1 and hypoxic markers [12] [13] . One of these studies demonstrated that upregulation of Glut1 and HIF-1a was closely associated with [ 18 F]FDG uptake into thymic cancer cells [12] . "
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    ABSTRACT: The purpose of this study was to systemically review the available literature regarding the diagnostic performance of positron emission tomography (PET) using 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG) in patients with thymic epithelial tumors. We reviewed 13 studies that evaluated the diagnostic role of thymic epithelial tumors with [18F]FDG-PET. [18F]FDG-PET is a useful radiological modality for differentiating between thymomas and thymic carcinoma. However, [18F]FDG-PET may not be useful for differentiating low-risk thymoma and high-risk thymoma. One paper reported that [18F]FDG-PET has a predictive significance for treatment and prognosis in thymic epithelial tumors. Two papers reported that the degree of [18F]FDG uptake in thymic epithelial tumors is based on glucose metabolism. [18F]FDG-PET may have a further use for radiological differential diagnosis of thymomas and thymic carcinomas.
    Cancer Imaging 11/2011; 11(1):195-201. DOI:10.1102/1470-7330.2011.0028 · 2.07 Impact Factor
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    • "To this end, PET scans are useful in determining the prognosis of several tumors, as described for breast, lymphomas, thyroid, oral squamous cell carcinomas and other cancers,33,41,56,58,67 providing anatomical and metabolic data on tumors. PET scans have provided indirect evidence about the function of GLUT1 in carcinogenesis, and several studies have correlated glucose analog (18-F-FDG) uptake and tumor aggressiveness.68-70 "
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    ABSTRACT: To analyze glucose transporter 1 expression patterns in malignant tumors of various cell types and evaluate their diagnostic value by immunohistochemistry. Glucose is the major source of energy for cells, and glucose transporter 1 is the most common glucose transporter in humans. Glucose transporter 1 is aberrantly expressed in several tumor types. Studies have implicated glucose transporter 1 expression as a prognostic and diagnostic marker in tumors, primarily in conjunction with positron emission tomography scan data. Immunohistochemistry for glucose transporter 1 was performed in tissue microarray slides, comprising 1955 samples of malignant neoplasm from different cell types. Sarcomas, lymphomas, melanomas and hepatoblastomas did not express glucose transporter 1. Forty-seven per cent of prostate adenocarcinomas were positive, as were 29% of thyroid, 10% of gastric and 5% of breast adenocarcinomas. Thirty-six per cent of squamous cell carcinomas of the head and neck were positive, as were 42% of uterine cervix squamous cell carcinomas. Glioblastomas and retinoblastomas showed membranous glucose transporter 1 staining in 18.6% and 9.4% of all cases, respectively. Squamous cell carcinomas displayed membranous expression, whereas adenocarcinomas showed cytoplasmic glucose transporter 1 expression. Glucose transporter 1 showed variable expression in various tumor types. Its absence in sarcomas, melanomas, hepatoblastomas and lymphomas suggests that other glucose transporters mediate the glycolytic pathway in these tumors. The data suggest that glucose transporter 1 is a valuable immunohistochemical marker that can be used to identify patients for evaluation by positron emission tomography scan. The function of cytoplasmic glucose transporter 1 in adenocarcinomas must be further examined.
    Clinics (São Paulo, Brazil) 06/2011; 66(6):965-72. DOI:10.1590/S1807-59322011000600008 · 1.19 Impact Factor
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