Objective: to evaluate the feasibility of the intra-operative application of a specimen PET/CT imager in a clinical setting. Materials and methods: this is a pilot analysis performed in three patients who received an intra-operative administration of ⁶⁸Ga-PSMA-11 (n = 2) and ⁶⁸Ga-DOTA-TOC (n = 1), respectively. Patients were administrated with PET radiopharmaceuticals to perform radio-guided surgery with a beta-probe detector during radical prostatectomy for prostate cancer (PCa) and salvage lymphadenectomy for recurrent neuroendocrine tumor (NET) of the ileum, respectively. All procedures have been performed within two ongoing clinical trials in our Institute (NCT05596851 and NCT05448157). Pathologic assessment with immunohistochemistry (PSMA-staining and SSA immunoreactivity) was considered as standard of truth. Specimen images were compared with baseline PET/CT images and histopathological analysis. Results: Patients received 1 MBq/Kg of ⁶⁸Ga-PSMA-11 (PCa) or 1.2 MBq/Kg of ⁶⁸Ga-DOTA-TOC (NET) prior to surgery. Specimens were collected, positioned in the dedicated specimen container, and scanned to obtain high-resolution PET/CT images. In all cases, a perfect match was observed between the findings detected by the specimen imager and histopathology. Overall, the PET spatial resolution was sensibly higher for the specimen images compared to the baseline whole-body PET/CT images. Furthermore, the use of the PET/CT specimen imager did not significantly interfere with any procedures, and the overall length of the surgery was not affected using the PET/CT specimen imager. Finally, the radiation exposure of the operating theater staff was lower than 40 µSv per procedure (range 26–40 μSv). Conclusions: the image acquisition of specimens obtained by patients who received intra-surgery injections of ⁶⁸Ga-PSMA-11 and ⁶⁸Ga-DOTA-TOC was feasible and reliable also in a live-experience session and has been easily adapted to surgery daily practice. The high sensitivity, together with the evaluation of intra-lesion tumor heterogeneity, were the most relevant results since the data derived from specimen PET/CT imaging matched perfectly with the histopathological analysis.

Ecancermedicalscience is the peer-reviewed open access cancer journal founded by the European Institute of Oncology in Milan. We consider articles on all aspects of research relating to cancer, including molecular biology, genetics, pathophysiology, epide

To evaluate the association between radiomic features (RFs) extracted from ¹⁸F‐FDG PET/CT (¹⁸F‐FDG‐PET) with progression‐free survival (PFS) and overall survival (OS) in diffuse large‐B‐cell lymphoma (DLBCL) patients eligible to first‐line chemotherapy. DLBCL patients who underwent ¹⁸F‐FDG‐PET prior to first‐line chemotherapy were retrospectively analyzed. RFs were extracted from the lesion showing the highest uptake. A radiomic score to predict PFS and OS was obtained by multivariable Elastic Net Cox model. Radiomic univariate model, clinical and combined clinical‐radiomic multivariable models to predict PFS and OS were obtained. 112 patients were analyzed. Median follow‐up was 34.7 months (Inter‐Quartile Range (IQR) 11.3–66.3 months) for PFS and 41.1 (IQR 18.4–68.9) for OS. Radiomic score resulted associated with PFS and OS (p < 0.001), outperforming conventional PET parameters. C‐index (95% CI) for PFS prediction were 0.67 (0.58–0.76), 0.81 (0.75–0.88) and 0.84 (0.77–0.91) for clinical, radiomic and combined clinical‐radiomic model, respectively. C‐index for OS were 0.77 (0.66–0.89), 0.84 (0.76–0.91) and 0.90 (0.81–0.98). In the Kaplan‐Meier analysis (low‐IPI vs. high‐IPI), the radiomic score was significant predictor of PFS (p < 0.001). The radiomic score was an independent prognostic biomarker of survival in DLBCL patients. The extraction of RFs from baseline ¹⁸F‐FDG‐PET might be proposed in DLBCL to stratify high‐risk versus low‐risk patients of relapse after first‐line therapy, especially in low‐IPI patients.

The first “theragnostic model”, that of radioiodine, was first applied both in diagnosis and therapy in the 1940s. Since then, many other theragnostic models have been introduced into clinical practice. To bring about the closest pharmacokinetic connection, the radiocompound used for diagnosis and therapy should be the same, although at present this is rarely applicable. Today, a widely applied and effective model is also the “DOTA-Ga-68/Lu-177”, used with success in neuroendocrine tumors (NET). In this paper, we analyze the necessary steps from the in vitro evaluation of a target to the choice of radionuclide and chelate for therapy up to in vivo transition and clinical application of most employed radiocompounds used for theragnostic purposes. Possible future applications and strategies of theragnostic models are also highlighted.