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A case of negative HER2 immunostaining of advanced gastric carcinoma (Moderately differentiated tubular adenocarcinoma, pT4aN1, tumor size: 3×2.5cm). Upper gastrointestinal endoscopy view (A) and enhanced CT (B) showed ulcerative mass in the lesser curvature of gastric antrum. 18 F-FDG PET-CT image (C) revealed focal increased FDG uptake in gastric antrum (SUVmax = 3.5). C-erbB2 immunostaining (D) showed negative result.
Source publication
Objectives:
Expression of HER2 in gastric carcinoma has direct prognostic and therapeutic implications in patient management. The aim of this study is to determine whether a relationship exists between standardized uptake value (SUV) and expression of HER2 in advanced gastric carcinoma.
Methods:
We analyzed the (18)F-FDG PET/CT results of 109 pa...
Context in source publication
Context 1
... 26 patients (23.8%) showed positivity for overexpression of HER2. The correlations of HER2 overexpression with clinicopathologic factors are presented in Table 1. The mean level of SUV max in the tumor groups with scores 0 and 1+ was 3.9±2.1 and in the tumor groups with a score 2+ and 3+ was 6.3±3.7. The difference in SUV max between the two groups was significant (P=0.02) (Figure 2, ...
Similar publications
Objective. To evaluate the HER2 expression on gastric adenocarcinoma from a Brazilian population and also to analyze the relations between the receptor and clinical characteristics, as well as the survival status. Materials and Methods. A retrospective analysis was conducted from January of 2008 to July of 2012, considering only gastrectomies with...
Citations
... and their impact on survival in gastric cancer. Regarding tumor size, there are studies claiming that SUVmax is higher in tumors > 5cm [21,22], while other studies have shown no such correlation [17,18]. In our study, we only found a correlation between MTV and TLG with tumor size, but no signi cant relationship was found with SUVmax. ...
... Chen et al. found no association between HER2 status and SUVmax in their study, but when excluding patients with signet ring cell carcinomas, they observed higher SUVmax values in HER2-negative patients compared to HER2-positive patients [22]. Conversely, other studies by Kim [21,27]. In line with our ndings, studies by Ertürk et al. and Celli et al. did not nd a statistically signi cant relationship between HER2 status and SUVmax [23,24]. ...
... In our study, we identi ed a signi cant relationship between HER2 positivity and tumor location in the cardia region among tubular adenocarcinomas without signet ring cells or mucinous components. However, other studies did not consistently observe this relationship [21,22,23,24]. ...
Aim
This study aimed to investigate the relationship between pathological data with strong importance to Human Epidermal Growth Factor Receptor 2 (HER2) status, and pre-treatment 18F-FDG PET/CT semi-quantitative metabolic parameters in gastric adenocarcinomas and their impact on survival.
Methods
A retrospective analysis was conducted on 117 patients with gastric cancer who underwent 18F-FDG PET/CT for staging. PET/CT results were evaluated for SUVmax, SUVmean, metabolic tumor volume (MTV), total lesion glycolysis (TLG), HER2 status, pathological data, and tumor markers.
Results
Of the 117 patients, 17.1% were HER2 + and 82.9% were HER2-. SUVmax was significantly lower in tubular adenocarcinoma (TA) patients with signet ring cell (SRC) component compared to those without SRC component. Tumor size > 5 cm positively correlated with MTV and TLG in patients who underwent total resection. Vascular invasion and local invasion (T3/T4) were associated with higher SUVmax. Patients with distant metastasis had significantly higher SUVmax, SUVmean, and TLG. Stage 3/4 patients showed positive correlations with CEA and CA19-9 values. The tumor's localization in the cardia correlated significantly with HER2 positivity in the TA group. Survival analysis revealed higher 1-year and 3-year survival rates in the HER2 + group compared to the HER2- group.
Conclusion
18F-FDG PET/CT evaluation for staging provides non-invasive guiding findings for treatment and prognosis. The histological components should be performed in tubular adenocarcinomas PET/CT can predict histological components, local invasion, and vascular invasion. Evaluating metabolic parameters in the primary tumor focus using PET/CT can demonstrate the presence of distant metastasis. The relationship between tumor localization in the cardia and HER2 positivity may be useful in predicting anti-HER2 antibody treatment options. Further extensive studies are needed on this topic.
... Therefore, research on the value of imaging tools in the identification of HER2 status has gradually become the focus of renewed interest. Although prior research involving PET/CT has suggested that HER2 expression in GC may be associated with the SUV [8-12], reports are conflicting, with nonstandard grouping occurring in some studies [8][9][10]. A recent CT-based study affirmed the value of some CT characteristics in differentiating HER2-positive from HER2-neg-1 ...
OBJECTIVE. The purpose of this article is to evaluate interobserver, intraobserver, and interplatform variability and compare the previously established association between texture metrics and tumor histologic subtype using three commercially available CT texture analysis (CTTA) software platforms on the same dataset of large (> 7 cm) renal cell carcinomas (RCCs). MATERIALS AND METHODS. CT-based texture analysis was performed on contrast-enhanced MDCT images of large (> 7 cm) untreated RCCs in 124 patients (median age, 62 years; 82 men and 42 women) using three different software platforms. Using this previously studied cohort, texture features were compared across platforms. Features were correlated with histologic subtype, and strength of association was compared between platforms. Single-slice and volumetric measures from one platform were compared. Values for interobserver and intraobserver variability on a tumor subset (n = 30) were assessed across platforms. RESULTS. Metrics including mean gray-level intensity, SD, and volume correlated fairly well across platforms (concordance correlation coefficient [CCC], 0.66-0.99; mean relative difference [MRD], 0.17-5.97%). Entropy showed high variability (CCC, 0.04; MRD, 44.5%). Mean, SD, mean of positive pixels (MPP), and entropy were associated with clear cell histologic subtype on almost all platforms (p < .05). Mean, SD, entropy, and MPP were highly reproducible on most platforms on both interobserver and intraobserver analysis. CONCLUSION. Select texture metrics were reproducible across platforms and readers, but other metrics were widely variable. If clinical models are developed that use CTTA for medical decision making, these differences in reproducibility of some features across platforms need to be considered, and standardization is critical for more widespread adaptation and implementation.
... Other tumors such as low-grade neuroendocrine, lymphomas and carcinoids as well as extensive superficial lesions, such as those with central necrosis may have a low 18 F-FDG uptake [1,36]. Moreover, several studies reported a lower 18 F-FDG -avidity and a lower SUV for diffuse subtype gastric cancer than for tumors of the intestinal type [11,[37][38][39][40][41]. A lower delectability of tumors in the proximal and middle thirds of the stomach had also been described due to the higher incidence of diffuse type tumors at these locations while more incidence of intestinal type tumors in distal third [9]. ...
Objectives:
To assess diagnostic accuracy and added value of dual time point 18F-FDG PET/CT after gastric distention using oral water in differentiating malignant from benign gastric lesions.
Methods:
Patients (n = 30, 19 males, mean age 58.6 ± 16.4 years). All patients are known or suspected oncology patients. All patients underwent whole body 18F-FDG PET/CT scan and 2 h delayed PET/CT abdominal images following oral water gastric distension. The best cut off values for early SUVmax (SUVmax1), delayed SUVmax (SUVmax2) and SUVmax2-SUVmax1 (ΔSUVmax) to differentiate benign from malignant lesions were set based on ROC analysis. Data analyzed included in addition; age, sex and 18F-FDG uptake pattern in delayed images. Suspicious gastric lesions were correlated with biopsy in 18 patients (60 %) and with clinical and follow-up imaging (18F-FDG PET/CT, CT or MRI) in 12 patients (40 %). Unpaired t-test was used to compare the mean deference in continuous variables between patients with gastric malignancy and those with benign gastric lesions. Fisher's exact test was used to analyze categorical variables. Logistic regression analysis was performed to identify the most powerful factors to predict malignant lesions.
Results:
Fifteen patients (50 %) had confirmed malignant gastric lesions. Patients with confirmed gastric malignancy were older (65 ± 13 vs 52 ± 17; p = 0.023) and had significantly higher mean ΔSUVmax (1.29 ± 1.76 vs -0.89 ± 1.59; p = 0.003). The mean SUVmax1 (6.99 ± 6.66 vs 5.31 ± 2.53; p = 0.367) and SUVmax2 (8.29 ± 7.41 vs 4.44 ± 3.34; p = 0.077) although both higher in patients with malignant lesions, they did not reach statistical significance. Sensitivity, specificity, PPV, NPV, and accuracy to detect malignant gastric lesions were highest for lesions with localized uptake pattern in delayed images post water oral contrast as well as for lesions with ΔSUVmax>0. Regression analysis revealed both variables as independent predictors for malignant lesions with odd ratios of 22.9 and 9.5 respectively and final model Chi-Square of 19.9 (p < 0.0001). The model correctly identified 12/15 (80 %) malignant lesions and 13/15 (86.7 %) benign lesions with 2 false positives confirmed as chronic active gastritis with helicobacter pylori and 3 false negatives including 1 signet ring gastric cancer and 1 low grade gastrointestinal stromal tumor (GIST), both with poor 18 F-FDG uptake.
Conclusion:
Localized uptake pattern in delayed PET/CT images following gastric distention with oral water contrast as well as ΔSUVmax>0 are powerful independent variables to identify malignant gastric lesions with fairly high sensitivity and reasonable accuracy. Malignancies with inherently low 18F-FDG avidity are the main cause of false negatives while active gastritis is the main cause of false positives.
... In clinical practice, HER2 was the first and only membrane-bound RTK to be successfully targeted in the treatment of patients with GC and GEJC [32]. Many studies have attempted to reveal the relationship between HER2 expression and FDG metabolism; however, the results remain controversial [10,33]. Specifically, while some studies have reported that the SUV max is significantly lower in HER2positive group than in the HER2-negative group [10], others have drawn the opposite conclusion [33]. ...
... Many studies have attempted to reveal the relationship between HER2 expression and FDG metabolism; however, the results remain controversial [10,33]. Specifically, while some studies have reported that the SUV max is significantly lower in HER2positive group than in the HER2-negative group [10], others have drawn the opposite conclusion [33]. Consistent with results reported by Celli et al. [34], our data demonstrate that there is no significant difference in SUV max between HER2 + and HER2− groups, implying that this marker cannot be used to predict the HER2 expression status of GEJC on initial staging. ...
Objective
The aim of this study was to evaluate PET/FDG metabolic parameters in locally advanced GEJC and correlate it with molecular pathological profiles.
Methods
We retrospectively analyzed data from 66 patients with a histopathological diagnosis of GEJC who had undergone ¹⁸F-FDG PET/CT before surgical resection. Maximum standardized uptake (SUVmax), mean standardized uptake (SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumor were measured and calculated using the region of interest (ROI) technique. The relationship between metabolic parameters and the Lauren’s classification, histologic differentiation, Ki-67 staining and positivity for human epidermal growth factor receptor 2 (HER2), c-Met, and epidermal growth factor receptor (EGFR) were investigated through immunohistochemical (IHC) analyses.
Results
Of the total 66 patients, significant differences were observed between intestinal and non-intestinal (mixed and diffuse) adenocarcinomas in SUVmax (8.23 ± 2.83 vs. 6.29 ± 2.41, P = 0.008), SUVmean (4.85 ± 1.47 vs. 3.93 ± 1.22, P = 0.017), MTV (24.96 cm³ vs. 8.90 cm³; P = 0.004), and TLG (97.38 cm³ vs. 37.09 cm³, P = 0.005) values. SUVmax, MTV, and TLG of moderately differentiated adenocarcinomas were significantly higher than those of the poorly differentiated ones. SUVmax was significantly higher in tissues with a higher Ki-67 index or in the c-MET-negative group (P = 0.045, P = 0.036). No significant correlation was found between metabolic parameters and the expression of HER2 or EGFR in GEJC.
Conclusion
¹⁸F-FDG PET/CT may be useful for predicting the molecular pathological profiles of GEJC and for determining appropriate therapeutic strategy.
... [7,19,21] In addition, tumor size was shown to correlate not only with detectability but also with the SUV of the primary gastric cancer. [20,22,23] For example, Han et al showed that gastric tumor size was positively related to the SUV max (3.0 ± 0.4 for tumors <1 cm, 3.9 ± 2.1 for those 1-3 cm, and 5.7 ± 3.2 for those <3 cm). Other studies, however, did not find an effect of the primary tumor size on tumor detectability by 18 F-FDG PET/ CT. [10,24,25] Our study also showed a higher rate of FDG-avidity for tumors in the lower 3rd than those in the upper or middle 3rd of the stomach. ...
... [26] The Lauren classification has been consistently related to 18 F-FDG uptake in gastric tumors, with a higher rate of FDG-avidity and a higher SUV for intestinal type tumors than for tumors of the nonintestinal type. [7,19,[22][23][24]26] Our patients with intestinal type EGCs also had a higher rate of 18 F-FDG uptake than did those with diffuse type EGCs (21.4% vs 6.1%, P = .016). Furthermore, tumors in the lower 3rd of the stomach were more frequently of the intestinal type than were those in the upper or middle 3rd (56.6% vs 45.3%, P = .037). ...
This study investigated the clinicopathologic factors associated with 2-[¹⁸F]fluoro-2-deoxy-d-glucose (¹⁸F-FDG) uptake of early gastric cancer (EGC) and used them to design a clinical scoring method to predict FDG-avidity of EGC.
Two hundred twenty-nine retrospectively enrolled patients underwent preoperative ¹⁸F-FDG positron emission tomography/computed tomography (PET/CT). Histologic information was obtained by gastrectomy (n = 195) or endoscopic mucosal dissection (n = 34). The association between clinicopathologic factors and ¹⁸F-FDG uptake by the primary tumor was determined. The results were used to develop a clinical scoring method.
¹⁸F-FDG uptake was detected in 49 (17.5%) patients. According to univariate analysis, location, gross type, World Health Organization classification, Lauren classification, size, depth of invasion, and lymphatic invasion were significant variables affecting ¹⁸F-FDG uptake (all P < .05). According to multivariate analysis, location (lower 3rd, P = .035), gross type (0–I, 0–IIa, P < .001), size (≥2.5 cm, P = .026), and depth of invasion (submucosa, P = .007) were significantly associated with FDG-avidity. A clinical scoring system, ranged from 0 to 4, was developed by giving one score to 4 independent variables. A cut-off value of 2.5 showed good prediction of FDG-avidity in EGCs, with a sensitivity and specificity of 65.0% and 85.2%, respectively.
¹⁸F-FDG uptake by EGC depends on location, gross type, size, and depth of invasion of the primary tumor. A clinical scoring system based on clinicopathologic variables can predict the FDG-avidity of primary tumors in patients with EGC.
Objectives:
Human epidermal growth factor receptor-2 (HER-2) is a protooncogene encoded by ERBB2 on chromosome 17. 18Fluoridefluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) examination is frequently used to detect distant metastasis in gastric cancer imaging. This study aimed to investigate the relationship between the data obtained in the 18F-FDG PET/CT examination and HER-2 expression status in patients with gastric cancer.
Methods:
A total of 115 patients diagnosed with gastric cancer between 2016 and 2020, with HER-2 immunohistochemical followed by 18F-FDG PET/CT examination for staging purposes were included.
Results:
HER-2 immunohistochemical examination revealed 71 patients (61.7%) with negative and 44 (38.3%) with positive results. The median maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) values of patients positive with HER-2 were 9.95, 5, 30.44, and 139.16, respectively, whereas patients negative with HER-2 were 9.3,5.4,36.62, and 190.424, respectively (p>0.05). The median cancer antigen 19-9 (CA 19-9) levels of patients positive with HER-2 was 33.52, whereas 11.79 in those who were negative (p=0.016). The mean age was 69.3±9.35 years in patients with distant metastases, whereas 65.2±10.9 in those without distant metastases (p=0.042). Median SUVmax and SUVmean values in patients with distant metastases were 11.1 and 6.3, respectively, and 8.2 and 4.5 in those without distant metastases (p=0.002 and p=0.001, respectively). The median CA 19-9 and carcinoembryonic antigen (CEA) levels in patients with distant metastases were 31.34 and 9.20, respectively, whereas those without distant metastases were 11.55 and 2.26, respectively (p=0.011 and p=0.001, respectively).
Conclusion:
In our study, no statistically significant difference was found in terms of HER-2 status, SUVmax, SUVmean, MTV, TLG, distant metastasis, presence of lymph node metastasis, age, gender, tumor diameter, grade, and localization, and CEA levels in patients with gastric cancer. A statistically significant difference was found between HER-2 status and CA 19-9 levels. A statistically significant relationship was found between distant metastases in the 18F-FDG PET/CT examination and SUVmax, SUVmean, age, CEA levels, and histopathologic diagnosis; however, the relationship between distant metastasis in the 18F-FDG PET/CT scan and MTV, TLG, tumor diameter, localization, and grade was not statistically significant.
