Combining Diagnostic Imaging and Pathology for Improving Diagnosis and Prognosis of Cancer

Abstract

In the era of personalized medicine, the management of oncological patients requires a translational and multidisciplinary approach. During early phases of cancer development, biochemical alterations of cell metabolism occur much before the formation of detectable tumour masses. Current molecular imaging techniques, targeted to the study of molecular kinetics, employ molecular tracers capable of detecting cancer lesions with both high sensitivity and specificity while also providing essential information for both prognosis and therapy. On the contrary, complementary and crucial information is provided by histopathological examination and ancillary techniques such as immunohistochemistry. Thus, the successful collaboration between diagnostic imaging and anatomic pathology can represent a fundamental step in the "tortuous" but decisive path towards personalized medicine.

Figure 1

Evaluation of in situ breast cancer biomarkers. Image showing (a) Ki67 nuclear expression in an infiltrating breast cancer, (b) expression of ER in an infiltrating breast cancer, (c) PR expression in an infiltrating breast cancer, and (d) HER2 expression (score 3) in an infiltrating breast cancer.

Figure 2

99mTc sestamibi SPECT analysis and histological evaluation of a triple-negative breast cancer. (a) Image showing the uptake of sestamibi in a cancer lesion characterized by a high proliferation rate (Ki67). Immunohistochemical analysis displaying triple-negative phenotypes of breast lesions: (b) ER negative; (c) PR negative; (d) HER2 score 0.

Figure 3

99mTc sestamibi SPECT analysis and histological evaluation in a breast cancer patient. (a) Image showing sestamibi uptake in a breast cancer patients. (b) Histological evaluation (H&E) of the breast biopsy of the patient subjected to 99mTc sestamibi SPECT. (c) Sentinel lymph node with macrometastasis. Immunohistochemical analysis of lymph nodes displaying triple-positive phenotypes of breast cancer cells: (d) ER positive; (e) PR positive; (f) HER2 score 3.

Figure 4

¹⁸F-choline PET analysis and histological evaluation in a prostate cancer patient. Images showing (a, b) the uptake of ¹⁸F-choline in a prostate cancer lesion, (c) PSA expression in a prostate cancer biopsy, and (d) ck34be12 expression in a prostate cancer.