Article Figures & Data
Figures
- FIGURE 1.
18F-FLT PET/CT images of patient 9 (pT2pN0M0 oral cavity carcinoma). Top panels show PET images, middle panels show CT images, and bottom panels show fusion of both image modalities. Cervical lymph nodes with increased 18F-FLT uptake are found bilaterally in level II (A, arrowheads) and in levels III and IV (B, arrowheads). All lymph nodes detected with 18F-FLT in this example were false-positive for metastasis, due to uptake in proliferating B-lymphocytes in reactive germinal centers.
- FIGURE 2.
Ki-67 and IdUrd staining. (A) Germinal center harboring proliferating B-lymphocytes and remaining lymphoid tissue. (B) Remaining lymphoid tissue with proliferating lymphoid cells. (C) Metastasis of squamous cell carcinoma of maxillary sinus. (D) Micrometastasis with keratinization (purple arrow), fragment of a germinal center (white arrow), and surrounding lymphoid tissue. (×100)
- FIGURE 3.
Ki-67 LI (A) and IdUrd LI (B) in germinal centers (GC), remaining lymphoid tissue (LT), and metastases (MET).
- FIGURE 4.
(A) Absolute area (in mm2) occupied by germinal centers in true-negative (TN; 18F-FLT-negative lymph node without metastasis), false-positive (FP; 18F-FLT-positive lymph node without metastasis), and true-positive (TP; 18F-FLT-positive lymph node with metastasis) lymph nodes. Ki-67germinal center (B) and IdUrdgerminal center (C) in TN and FP lymph nodes as measure of total proliferative activity in germinal centers (calculated as area in mm2).
- FIGURE 5.
Scatter plot of Ki-67lymph node (A) and scatter plot of IdUrdlymph node (B) as measure of total proliferative activity in lymph node (calculated as area in mm2) versus SUVmean of 18F-FLT PET. Solid lines indicate linear best fit.
Tables
- TABLE 1
Patient Characteristics, Diagnostic and Therapeutic Procedures, and Histopathology of Lymph Nodes
Patient no. US and FNA cytology (side) Clinical stage Pathologic stage Pathology LN (no. of Pathologic LN) LN positive on PET* (no. of LN indicated) LN positive on PET† (no. and side of LN indicated) Site CT MRI Procedure L R L R 1 Maxillary sinus POS (L) NP POS T4N1M0 pT4pN1M0 TE + MRND, L POS (1) NA 1 NA 1, R 2 Laryngeal NP NEG NP T3N0M0 pT3pN0M0 TLE + bilateral NS NEG NEG 1 1 2, R 3 Laryngeal NP POS NP T4N2cM0 pT4pN2cM0 TLE + bilateral RND POS (7) POS (5) 2 2 1, R 4 Lower alveolar ridge NEG (L) NEG NP T4N2bM0 pT4pN0M0 TE + MRND, R NA NEG NA 2 2, L 5 Floor of mouth NR NP NP T2N0M0 pT2pN0M0 TE + bilateral SND NEG NEG NEG NEG — 6 Tongue NEG (R) NP NP T3N0M0 pT2pN0M0 TE + SND, R NA NEG — 5 — 7 Soft palate NP NP NP T2N0M0 pT2pN0M0 TE + SND, L NEG NA NEG NA 1, R 8 Tongue NP NP NEG T3N0M0 pT3pN1M0 TE + SND, R NA POS (1) — 1 1, R 9 Tongue/floor of mouth NEG (L) NP NEG T4N0M0 pT2pN0M0 TE + SND, L NEG NA 3 NA 2, R 10 Tongue/floor of mouth NEG (L) NP NEG T2N0M0 pT2pN0M0 TE + SND, L NEG NA 2 — — ↵* Available for pathologic assessment.
↵† Not available for pathologic assessment.
LN = lymph node; FNA = fine-needle aspiration; NP = not performed; POS = positive; TE = tumor excision; MRND = modified radical neck dissection; NA = not available; NEG = negative; TLE = total laryngectomy; NS = node sampling; RND = radical neck dissection; NR = not representative; SND = selective neck dissection (level I–III).
- TABLE 2
Histologic Lymph Node Assessment: SUVmean, Histopathology, and Mean Ki-67 and IdUrd Staining
Patient no. LN level Pathology Ki-67 and IdUrd staining 18F-FLT POS SUVmean 18F-FLT NEG Metastasis Group Metastasis Germinal centers Remaining LN tissue 1 R II 1.5 NA L III − TN − + + L II 2.9 + TP + − + 2 R II 1.2 − FP − ++ + R III 0.9 NA R IV 1.2 NA L III 1.1 − FP − ++ + 3 R II 1.2 NA R III 1.3 + TP + ++ + R IV 1.1 + TP + ++ + L II 1.7 + TP + − − L IV 1.3 + TP + + + 4 R II 1.4 − FP − ++ + R III − TN − − + R IV 1.1 − FP − − + R V − TN − ++ + L II 1.0 NA L IV 0.8 NA 5 R I − TN − + + L II − TN − + ++ 6 R I 1.4 − FP − ++ ++ R II 1.3 − FP − ++ ++ R III 0.9 − FP − + + 7 R IV 1.5 NA L I − TN − ++ + L III − TN − ++ + 8 R II 1.0 + TP + ++ + R III 0.8 NA 9 R II 2.1 NA R IV 1.0 NA L II 1.3 − FP − ++ + L III 2.0 − FP − + + L IV 1.0 − FP − + + L I − TN − − + 10 L II 1.6 − FP − + ++ L III 1.3 − FP − + ++ LN = lymph node; POS = positive; NEG = negative; II = level indicated by roman number, NA = not available; TN = true-negative 18F-FLT-negative lymph node without metastasis; TP = true-positive 18F-FLT-positive lymph node with metastasis; FP = false-positive 18F-FLT-positive lymph node without metastasis.
- TABLE 3
Ki-67 LI and IdUrd LI in Germinal Centers, Remaining Lymphoid Tissue, and Metastases
Ki-67 LI Germinal centers Remaining lymphoid tissue Metastases Parameter TN FP TP Overall TN FP TP Overall TP Mean 58.6 52.1 50.5 53.9 3.7 2.8 7.4 3.8 26.8 SD 16.6 13.2 4.2 13.8 1.9 2.4 7.5 3.6 7.7 Median 55.1 53.1 49.5 52.8 3.6 2.5 4.6 3.3 26.7 IdUrd LI Germinal centers Remaining lymphoid tissue Metastases Parameter TN FP TP Overall TN FP TP Overall TP Mean 33.5 27.4 23.0 28.8 1.4 1.8 4.2 2.1 10.4 SD 15.7 9.4 4.5 11.7 0.7 1.3 6.4 2.8 6.1 Median 29.6 23.9 24.9 25.7 1.6 1.6 1.5 1.6 9.3 TN = true-negative (18F-FLT-negative lymph node without metastasis); FP = false-positive (18F-FLT-positive lymph node without metastasis); TP = true-positive (18F-FLT positive lymph node with metastasis).
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