Skip to main content

FLT PET/CT-Guided Biopsy in the Evaluation of Cancer

  • Chapter
  • First Online:
Oncological PET/CT with Histological Confirmation

Abstract

Deregulated cell cycle progression is a hallmark of cancer [1, 2]. The majority of therapeutic drugs have been designed to inhibit cell proliferation and/or to induce apoptosis. Metabolic imaging with positron emission tomography (PET) and the glucose analog 2′-[18F]fluoro-2′-deoxyglucose (18F-FDG) is a sensitive imaging modality to detect malignant tumors and to identify response to therapy early in the course of anticancer treatment [3, 4].18F-FDG is also a valuable clinical tool for predicting tumor response to therapy and patient survival [5, 6]. However, tumoral uptake of 18F-FDG is a biomarker of glucose metabolism and is associated with false positive findings in inflammatory processes [7, 8].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell. 2011;144(5):646–74.

    Article  CAS  PubMed  Google Scholar 

  2. Hanahan D, Weinberg RA. The hallmarks of cancer. Cell. 2000;100(1):57–70.

    Article  CAS  PubMed  Google Scholar 

  3. Barentsz J, Takahashi S, Oyen W, Mus R, De Mulder P, Reznek R, Oudkerk M, Mali W. Commonly used imaging techniques for diagnosis and staging. J Clin Oncol. 2006;24(20):3234–44.

    Article  CAS  PubMed  Google Scholar 

  4. von Schulthess GK, Steinert HC, Hany TF. Integrated PET/CT: current applications and future directions. Radiology. 2006;238(2):405–22.

    Article  Google Scholar 

  5. Herrmann K, Benz MR, Krause BJ, Pomykala KL, Buck AK, Czernin J. (18)F-FDG-PET/CT in evaluating response to therapy in solid tumors: where we are and where we can go. Q J Nucl Med Mol Imaging. 2011;55(6):620–32.

    CAS  PubMed  Google Scholar 

  6. Juweid ME, Cheson BD. Positron-emission tomography and assessment of cancer therapy. N Engl J Med. 2006;354(5):496–507.

    Article  CAS  PubMed  Google Scholar 

  7. Kubota R, Kubota K, Yamada S, Tada M, Ido T, Tamahashi N. Microautoradiographic study for the differentiation of intratumoral macrophages, granulation tissues and cancer cells by the dynamics of fluorine-18-fluorodeoxyglucose uptake. J Nucl Med. 1994;35(1):104–12.

    CAS  PubMed  Google Scholar 

  8. Shreve PD, Anzai Y, Wahl RL. Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variants. Radiographics. 1999;19(1):61–77. quiz 150–151.

    Article  CAS  PubMed  Google Scholar 

  9. Wells P, Gunn RN, Alison M, Steel C, Golding M, Ranicar AS, Brady F, Osman S, Jones T, Price P. Assessment of proliferation in vivo using 2-[(11)C]thymidine positron emission tomography in advanced intra-abdominal malignancies. Cancer Res. 2002;62(20):5698–702.

    CAS  PubMed  Google Scholar 

  10. Shields AF, Grierson JR, Dohmen BM, Machulla HJ, Stayanoff JC, Lawhorn-Crews JM, Obradovich JE, Muzik O, Mangner TJ. Imaging proliferation in vivo with [F-18]FLT and positron emission tomography. Nat Med. 1998;4(11):1334–6.

    Article  CAS  PubMed  Google Scholar 

  11. Salskov A, Tammisetti VS, Grierson J, Vesselle H. FLT: measuring tumor cell proliferation in vivo with positron emission tomography and 3′-deoxy-3′-[18F]fluorothymidine. Semin Nucl Med. 2007;37(6):429–39.

    Article  PubMed  Google Scholar 

  12. Mankoff DA, Shields AF, Krohn KA. PET imaging of cellular proliferation. Radiol Clin North Am. 2005;43(1):153–67.

    Article  PubMed  Google Scholar 

  13. Bading JR, Shields AF. Imaging of cell proliferation: status and prospects. J Nucl Med. 2008;49 Suppl 2:64S–80.

    Article  CAS  PubMed  Google Scholar 

  14. Been LB, Suurmeijer AJ, Cobben DC, Jager PL, Hoekstra HJ, Elsinga PH. [18F]FLT-PET in oncology: current status and opportunities. Eur J Nucl Med Mol Imaging. 2004;31(12):1659–72.

    Article  PubMed  Google Scholar 

  15. Buck AK, Herrmann K, Shen C, Dechow T, Schwaiger M, Wester HJ. Molecular imaging of proliferation in vivo: positron emission tomography with [18F]fluorothymidine. Methods. 2009;48(2):205–15.

    Article  CAS  PubMed  Google Scholar 

  16. Herrmann K, Eckel F, Schmidt S, Scheidhauer K, Krause BJ, Kleeff J, Schuster T, Wester HJ, Friess H, Schmid RM, et al. In vivo characterization of proliferation for discriminating cancer from pancreatic pseudotumors. J Nucl Med. 2008;49(9):1437–44.

    Article  CAS  PubMed  Google Scholar 

  17. Buck AK, Halter G, Schirrmeister H, Kotzerke J, Wurziger I, Glatting G, Mattfeldt T, Neumaier B, Reske SN, Hetzel M. Imaging proliferation in lung tumors with PET: 18F-FLT versus 18F-FDG. J Nucl Med. 2003;44(9):1426–31.

    CAS  PubMed  Google Scholar 

  18. Chalkidou A, Landau DB, Odell EW, Cornelius VR, O’Doherty MJ, Marsden PK. Correlation between Ki-67 immunohistochemistry and 18F-fluorothymidine uptake in patients with cancer: a systematic review and meta-analysis. Eur J Cancer. 2012;48(18):3499–513.

    Article  CAS  PubMed  Google Scholar 

  19. van Waarde A, Elsinga PH. Proliferation markers for the differential diagnosis of tumor and inflammation. Curr Pharm Des. 2008;14(31):3326–39.

    Article  PubMed  Google Scholar 

  20. Barwick T, Bencherif B, Mountz JM, Avril N. Molecular PET and PET/CT imaging of tumour cell proliferation using F-18 fluoro-L-thymidine: a comprehensive evaluation. Nucl Med Commun. 2009;30(12):908–17.

    Article  CAS  PubMed  Google Scholar 

  21. Shields AF. Positron emission tomography measurement of tumor metabolism and growth: its expanding role in oncology. Mol Imaging Biol. 2006;8(3):141–50.

    Article  PubMed  Google Scholar 

  22. Tehrani OS, Shields AF. PET imaging of proliferation with pyrimidines. J Nucl Med. 2013;54(6):903–12.

    Article  CAS  PubMed  Google Scholar 

  23. Bos R, van Der Hoeven JJ, van Der Wall E, van Der Groep P, van Diest PJ, Comans EF, Joshi U, Semenza GL, Hoekstra OS, Lammertsma AA, et al. Biologic correlates of (18)fluorodeoxyglucose uptake in human breast cancer measured by positron emission tomography. J Clin Oncol. 2002;20(2):379–87.

    Article  CAS  PubMed  Google Scholar 

  24. Buck AK, Schirrmeister H, Mattfeldt T, Reske SN. Biological characterisation of breast cancer by means of PET. Eur J Nucl Med Mol Imaging. 2004;31 Suppl 1:S80–7.

    Article  PubMed  Google Scholar 

  25. Higashi K, Clavo AC, Wahl RL. Does FDG uptake measure proliferative activity of human cancer cells? In vitro comparison with DNA flow cytometry and tritiated thymidine uptake. J Nucl Med. 1993;34(3):414–9.

    CAS  PubMed  Google Scholar 

  26. Vesselle H, Grierson J, Muzi M, Pugsley JM, Schmidt RA, Rabinowitz P, Peterson LM, Vallieres E, Wood DE. In vivo validation of 3′deoxy-3′-[(18)F]fluorothymidine ([(18)F]FLT) as a proliferation imaging tracer in humans: correlation of [(18)F]FLT uptake by positron emission tomography with Ki-67 immunohistochemistry and flow cytometry in human lung tumors. Clin Cancer Res. 2002;8(11):3315–23.

    CAS  PubMed  Google Scholar 

  27. Moskowitz CH, Schoder H, Teruya-Feldstein J, Sima C, Iasonos A, Portlock CS, Straus D, Noy A, Palomba ML, O’Connor OA, et al. Risk-adapted dose-dense immunochemotherapy determined by interim FDG-PET in advanced-stage diffuse large B-Cell lymphoma. J Clin Oncol. 2010;28(11):1896–903.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Graf N, Herrmann K, Numberger B, Zwisler D, Aichler M, Feuchtinger A, Schuster T, Wester HJ, Senekowitsch-Schmidtke R, Peschel C, et al. [18F]FLT is superior to [18F]FDG for predicting early response to antiproliferative treatment in high-grade lymphoma in a dose-dependent manner. Eur J Nucl Med Mol Imaging. 2013;40(1):34–43.

    Article  CAS  PubMed  Google Scholar 

  29. Leonard JP, LaCasce AS, Smith MR, Noy A, Chirieac LR, Rodig SJ, Yu JQ, Vallabhajosula S, Schoder H, English P, et al. Selective CDK4/6 inhibition with tumor responses by PD0332991 in patients with mantle cell lymphoma. Blood. 2012;119(20):4597–607.

    Article  CAS  PubMed  Google Scholar 

  30. Li Z, Graf N, Herrmann K, Junger A, Aichler M, Feuchtinger A, Baumgart A, Walch A, Peschel C, Schwaiger M, et al. FLT-PET is superior to FDG-PET for very early response prediction in NPM-ALK-positive lymphoma treated with targeted therapy. Cancer Res. 2012;72(19):5014–24.

    Article  CAS  PubMed  Google Scholar 

  31. Troost EG, Vogel WV, Merkx MA, Slootweg PJ, Marres HA, Peeters WJ, Bussink J, van der Kogel AJ, Oyen WJ, Kaanders JH. 18F-FLT PET does not discriminate between reactive and metastatic lymph nodes in primary head and neck cancer patients. J Nucl Med. 2007;48(5):726–35.

    Article  PubMed  Google Scholar 

  32. Buck AK, Herrmann K, Buschenfelde CM, Juweid ME, Bischoff M, Glatting G, Weirich G, Moller P, Wester HJ, Scheidhauer K, et al. Imaging bone and soft tissue tumors with the proliferation marker [18F]fluorodeoxythymidine. Clin Cancer Res. 2008;14(10):2970–7.

    Article  CAS  PubMed  Google Scholar 

  33. Herrmann K, Ott K, Buck AK, Lordick F, Wilhelm D, Souvatzoglou M, Becker K, Schuster T, Wester HJ, Siewert JR, et al. Imaging gastric cancer with PET and the radiotracers 18F-FLT and 18F-FDG: a comparative analysis. J Nucl Med. 2007;48(12):1945–50.

    Article  CAS  PubMed  Google Scholar 

  34. Chen W, Cloughesy T, Kamdar N, Satyamurthy N, Bergsneider M, Liau L, Mischel P, Czernin J, Phelps ME, Silverman DH. Imaging proliferation in brain tumors with 18F-FLT PET: comparison with 18F-FDG. J Nucl Med. 2005;46(6):945–52.

    CAS  PubMed  Google Scholar 

  35. Ullrich R, Backes H, Li H, Kracht L, Miletic H, Kesper K, Neumaier B, Heiss WD, Wienhard K, Jacobs AH. Glioma proliferation as assessed by 3′-fluoro-3′-deoxy-L-thymidine positron emission tomography in patients with newly diagnosed high-grade glioma. Clin Cancer Res. 2008;14(7):2049–55.

    Article  CAS  PubMed  Google Scholar 

  36. Herrmann K, Erkan M, Dobritz M, Schuster T, Siveke JT, Beer AJ, Wester HJ, Schmid RM, Friess H, Schwaiger M, et al. Comparison of 3′-deoxy-3′-[(1)(8)F]fluorothymidine positron emission tomography (FLT PET) and FDG PET/CT for the detection and characterization of pancreatic tumours. Eur J Nucl Med Mol Imaging. 2012;39(5):846–51.

    Article  CAS  PubMed  Google Scholar 

  37. Herrmann K, Wieder HA, Buck AK, Schoffel M, Krause BJ, Fend F, Schuster T, Meyer zum Buschenfelde C, Wester HJ, Duyster J, et al. Early response assessment using 3′-deoxy-3′-[18F]fluorothymidine-positron emission tomography in high-grade non-Hodgkin’s lymphoma. Clin Cancer Res. 2007;13(12):3552–8.

    Article  CAS  PubMed  Google Scholar 

  38. Kasper B, Egerer G, Gronkowski M, Haufe S, Lehnert T, Eisenhut M, Mechtersheimer G, Ho AD, Haberkorn U. Functional diagnosis of residual lymphomas after radiochemotherapy with positron emission tomography comparing FDG- and FLT-PET. Leuk Lymphoma. 2007;48(4):746–53.

    Article  PubMed  Google Scholar 

  39. Weiler-Sagie M, Bushelev O, Epelbaum R, Dann EJ, Haim N, Avivi I, Ben-Barak A, Ben-Arie Y, Bar-Shalom R, Israel O. (18)F-FDG avidity in lymphoma readdressed: a study of 766 patients. J Nucl Med. 2010;51(1):25–30.

    Article  PubMed  Google Scholar 

  40. Buchmann I, Neumaier B, Schreckenberger M, Reske S. [18F]3′-deoxy-3′-fluorothymidine-PET in NHL patients: whole-body biodistribution and imaging of lymphoma manifestations--a pilot study. Cancer Biother Radiopharm. 2004;19(4):436–42.

    CAS  PubMed  Google Scholar 

  41. Buck AK, Bommer M, Stilgenbauer S, Juweid M, Glatting G, Schirrmeister H, Mattfeldt T, Tepsic D, Bunjes D, Mottaghy FM, et al. Molecular imaging of proliferation in malignant lymphoma. Cancer Res. 2006;66(22):11055–61.

    Article  CAS  PubMed  Google Scholar 

  42. Graf N, Herrmann K, den Hollander J, Fend F, Schuster T, Wester HJ, Senekowitsch-Schmidtke R, zum Buschenfelde CM, Peschel C, Schwaiger M, et al. Imaging proliferation to monitor early response of lymphoma to cytotoxic treatment. Mol Imaging Biol. 2008;10(6):349–55.

    Article  PubMed  Google Scholar 

  43. Herrmann K, Buck AK, Schuster T, Rudelius M, Wester HJ, Graf N, Scheuerer C, Peschel C, Schwaiger M, Dechow T, et al. A pilot study to evaluate 3′-deoxy-3′-18F-fluorothymidine pet for initial and early response imaging in mantle cell lymphoma. J Nucl Med. 2011;52(12):1898–902.

    Article  CAS  PubMed  Google Scholar 

  44. Herrmann K, Buck AK, Schuster T, Junger A, Wieder HA, Graf N, Ringshausen I, Rudelius M, Wester HJ, Schwaiger M, et al. Predictive value of initial 18F-FLT uptake in patients with aggressive non-Hodgkin lymphoma receiving R-CHOP treatment. J Nucl Med. 2011;52(5):690–6.

    Article  PubMed  Google Scholar 

  45. Wang R, Zhu H, Chen Y, Li C, Li F, Shen Z, Tian J, Yu L, Xu B. Standardized uptake value based evaluation of lymphoma by FDG and FLT PET/CT. Hematol Oncol. 2013;32:126–32.

    Article  CAS  PubMed  Google Scholar 

  46. Buck AK, Hetzel M, Schirrmeister H, Halter G, Moller P, Kratochwil C, Wahl A, Glatting G, Mottaghy FM, Mattfeldt T, et al. Clinical relevance of imaging proliferative activity in lung nodules. Eur J Nucl Med Mol Imaging. 2005;32(5):525–33.

    Article  PubMed  Google Scholar 

  47. Eckel F, Herrmann K, Schmidt S, Hillerer C, Wieder HA, Krause BJ, Schuster T, Langer R, Wester HJ, Schmid RM, et al. Imaging of proliferation in hepatocellular carcinoma with the in vivo marker 18F-fluorothymidine. J Nucl Med. 2009;50(9):1441–7.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lucia Zanoni .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing

About this chapter

Cite this chapter

Zanoni, L., Buck, A.K., Herrmann, K. (2016). FLT PET/CT-Guided Biopsy in the Evaluation of Cancer. In: Cerci, J., Fanti, S., Delbeke, D. (eds) Oncological PET/CT with Histological Confirmation. Springer, Cham. https://doi.org/10.1007/978-3-319-27880-3_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-27880-3_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-27878-0

  • Online ISBN: 978-3-319-27880-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics