Figure 1.
Detecting Putative DAPI(+), CK(+), CD45(-) HD-CTCs by Fluid Biopsy.
A representative image of High Definition Circulating Tumor Cells (HD-CTCs) from a Stanford patient with stage I non-small cell lung cancer shown in composite immunofluorescence (A) and by Wright-Giemsa brightfield microscopy (B). HD-CTCs are characterized as 4′,6-diamidino-2-phenylindole (DAPI) positive with a nucleus that is larger than surrounding white blood cells (Blue, C), cytokeratin (CK) positive (Red, D) and CD45 leukocyte marker negative (Green, E).
Figure 2.
Non-small Cell Lung Cancer FDG PET-CT Imaging Features.
A three dimensional, maximum intensity projection, whole body 18F-FDG PET-CT (left). Physiologic uptake is seen in the brain, heart and liver with excretion through the renal pelvis and bladder. This tumor showed an intense FDG uptake with SUVmax of 19, SUVmean of 9.6, and TLG of 65.6 using a 50% SUVmax threshold (upper right). On CT, the lesion volume was estimated at 6.0 cm3 with a maximum diameter of 22 mm (lower right).
Table 1.
Clinical, CTC and FDG PET-CT Patient Characteristics by Center.
Figure 3.
FDG Uptake and CTC Features Correlation Matrix*.
TLG = Total Lesion Glycolysis; SUV = Standardized Uptake Value; PVC = Partial Volume Corrected; 10 M WBC = 10 Million White Blood Cells. Bolded numbers are significant by p-value <0.05. Half of the matrix only is presented since it is symmetric around one and correlations are shaded by the magnitude of correlation. *Spearman rank correlations are shown for 62 of 71 patients with data extracted by PET-VCAR.
Figure 4.
HD-CTC Scatter Plots for SUVmaxPVC and CT diameter*.
Non-metastatic patients are highlighted in red (see methods for definition) and the axes are shown as log2(x,y) for ease of interpretation. Increasing SUVmaxPVC (left) was weakly correlated (r = 0.27, p-value = 0.03) with increasing HD-CTC/10 M WBC count compared to tumor diameter on CT (right; r = 0.07, p-value = 0.60), which showed no correlation. *Shown for 62 of 71 patients with data extracted by PET-VCAR.