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Direct co-registration of [18F]FDG uptake and histopathology in surgically excised malignancies of the head and neck: a feasibility study

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Recent technical advancements in PET imaging have improved sensitivity and spatial resolution. Consequently, clinical nuclear medicine will be confronted with PET images on a previously unfamiliar resolution. To better understand [18F]FDG distribution at submillimetric scale, a direct correlation of radionuclide-imaging and histopathology is required.

Methods

A total of five patients diagnosed with a malignancy of the head and neck were injected with a clinical activity of [18F]FDG before undergoing surgical resection. The resected specimen was imaged using a preclinical high-resolution PET/CT, followed by slicing of the specimen. Multiple slices were rescanned using a micro-PET/CT device, and one of the slices was snap-frozen for frozen sections. Frozen sections were placed on an autoradiographic film, followed by haematoxylin and eosin staining to prepare them for histopathological assessment. The results from both autoradiography and histopathology were co-registered using an iterative co-registration algorithm, and regions of interest were identified to study radiotracer uptake.

Results

The co-registration between the autoradiographs and their corresponding histopathology was successful in all specimens. The use of this novel methodology allowed direct comparison of autoradiography and histopathology and enabled the visualisation of uncharted heterogeneity in [18F]FDG uptake in both benign and malignant tissue.

Conclusion

We here describe a novel methodology enabling the direct co-registration of [18F]FDG autoradiography with the gold standard of histopathology in human malignant tissue. The future use of the current methodology could further increase our understanding of the distribution of radionuclides in surgically excised malignancies and hence, improve the integration of pathology and molecular imaging in a multiscale perspective.

Trial registration

ClinicalTrials.gov Identifier: NCT05068687

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Acknowledgements

The authors would like to thank ir. Eva Kint for ensuring radioprotection during the course of the study, and dr. apr. Jeroen Verhoeven, PhD, and Dr. ir. Jens Mincke, PhD, for their assistance in performing the autoradiography of the samples.

Author information

Authors and Affiliations

  1. Department of Head and Skin, Ghent University, Ghent, Belgium

    Jens M. Debacker, Philippe Deron & Wouter Huvenne

  2. Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium

    Jens M. Debacker, Philippe Deron & Wouter Huvenne

  3. Department of Nuclear Medicine, UZ Brussel, Brussels, Belgium

    Jens M. Debacker

  4. In vivo Cellular and Molecular Imaging Laboratory (ICMI), Vrije Universiteit Brussel, Brussels, Belgium

    Jens M. Debacker

  5. Cancer Research Institute Ghent, Ghent, Belgium

    Jens M. Debacker, David Creytens, Benedicte Descamps, Koen Van de Vijver, Christian Vanhove & Wouter Huvenne

  6. Department of Electronics and Information Systems, Ghent University, Ghent, Belgium

    Luna Maris, Benedicte Descamps, Vincent Keereman & Christian Vanhove

  7. XEOS Medical, Ghent, Belgium

    Luna Maris & Vincent Keereman

  8. Department of Pathology, Ghent University Hospital, Ghent, Belgium

    Fleur Cordier, David Creytens & Koen Van de Vijver

  9. Department of Diagnostic Sciences, Ghent University, Ghent, Belgium

    David Creytens, Yves D’Asseler, Vanessa Schelfhout & Koen Van de Vijver

  10. INFINITY Lab, Ghent University, Ghent, Belgium

    Benedicte Descamps & Christian Vanhove

  11. Department of Medical Imaging, Nuclear Medicine, Ghent University Hospital, Ghent, Belgium

    Yves D’Asseler, Kathia De Man & Vanessa Schelfhout

  12. Department of Pathology, Antwerp University Hospital, Edegem, Belgium

    Sasha Libbrecht

Authors
  1. Jens M. Debacker
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  2. Luna Maris
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Contributions

JD, VK, CV, & WH conceptualised the study; JD, LM, VK, DC, KVdV, & BD designed the study; JD, WH, & PhD screened patients; JD, WH, & PhD enrolled patients; JD collected the clinical data; JD, LM, FC, & CV performed image analysis; FC, DC, KVdV, & SL performed pathological analysis; JD & LM performed data analysis; JD drafted the paper. Writing - review and editing: JD, FC, LM, DC, PhD, BD, YD, KDM, VK, SL, VS, KVdV, CV, & WH; WH coordinated and supervised the project’s activities. All the authors critically revised the paper and approved the submitted version of the manuscript.

Corresponding author

Correspondence to Jens M. Debacker.

Ethics declarations

Ethics approval

The committee for medical ethics of the Ghent University Hospital approved the initial study on August 26, 2019, with local authorisation code 2019/1135. The amendment for performing additional sectioning and autoradiography was approved January 21, 2021.

Consent to participate

All subjects included in the current trial have given written informed consent to participate.

Consent for publication

All subjects included in the current trial have given written informed consent regarding the publication of the study data.

Conflict of interest

Vincent Keereman is a shareholder and board member of XEOS Medical and Luna Maris is an employee of XEOS Medical. The other authors have no financial or personal relationship with other people or organisations that could inappropriately influence or bias the currently submitted work.

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This article is part of the Topical Collection on Oncology - Head and Neck.

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Debacker, J., Maris, L., Cordier, F. et al. Direct co-registration of [18F]FDG uptake and histopathology in surgically excised malignancies of the head and neck: a feasibility study. Eur J Nucl Med Mol Imaging 50, 2127–2139 (2023). https://doi.org/10.1007/s00259-023-06153-z

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