Frontiers in Oncology最新文献

{"title":"Arthroscopic-assisted uniportal spinal surgery for recurrent lumbar schwannoma: a hybrid approach case report.","authors":"Yubo Zhang, Chen Meng, Yongqiang Li, En Song, Dapeng Li","doi":"10.3389/fonc.2026.1884458","DOIUrl":"10.3389/fonc.2026.1884458","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the management of recurrent lumbar schwannomas located within the intertransverse space and psoas compartment using a single-incision hybrid approach that combines open surgery with Arthroscopic-Assisted Uniportal Spinal Surgery (AUSS).</p><p><strong>Methods: </strong>A 78-year-old woman presented with a 1-month history of low back pain and left-sided radiculopathy. Seventeen years earlier, she had undergone lumbar schwannoma removal. MRI revealed multiple recurrent tumors along the left L4 nerve root, including lesions in the paraspinal and deep intertransverse-psoas compartments. A hybrid surgical strategy was employed: superficial tumors were resected via an open approach, and deeper lesions were removed endoscopically using AUSS through the same incision.</p><p><strong>Results: </strong>All tumors were successfully excised en bloc. AUSS provided high-definition visualization that facilitated circumferential dissection of a tumor densely adherent to the L4 nerve root. The patient experienced rapid relief of symptoms postoperatively, with complete resolution of radicular pain. Follow-up CT/MRI confirmed full tumor resection and adequate neural decompression. Histopathology confirmed multiple schwannomas.</p><p><strong>Conclusion: </strong>A combined open-AUSS approach through a single incision offers a feasible and safe option for treating recurrent lumbar schwannomas extending across multiple anatomical compartments. This hybrid strategy minimizes tissue disruption and may represent an effective alternative for managing complex recurrent paraspinal tumors.</p>","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":"16 ","pages":"1884458"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adipokine regulation of immune cell polarization in oral cancer and its impact on chemotherapy sensitivity.","authors":"Puguan Wang, Jiakai Qiao, Junnan Qi, Huen Li, Jiatong Li, Kunyu Lin, Bei Chang","doi":"10.3389/fonc.2026.1954382","DOIUrl":"https://doi.org/10.3389/fonc.2026.1954382","url":null,"abstract":"<p><p>Oral squamous cell carcinoma (OSCC) is the most common malignant tumor in the head and neck region. In locally advanced patients, neoadjuvant chemotherapy centered on cisplatin and 5-fluorouracil often leads to primary/acquired resistance, with a 5-year survival rate of less than 50%. Tumor microenvironment (TME) immunosuppressive remodeling is the core cause of chemotherapy failure. Adipokines secreted by cancer-associated adipocytes (CAAs) are the key mediators that link metabolic disorders, immune polarization and chemotherapy resistance. The adipokines leptin, adiponectin, chemerin, resistin, and GDF15 signal through pathways such as JAK2/STAT3, PI3K/AKT, NF-κB, and PPARγ to bidirectionally regulate the polarization phenotypes of tumor-associated macrophages (TAMs), myeloid-derived suppressor cells (MDSCs), CD4⁺/CD8⁺ T cells, and NK cells. Pro-cancer adipokines induce M2-type TAMs, MDSCs expansion, Th2/Th17 polarization, and effector T cell exhaustion, constructing an immunosuppressive microenvironment, upregulating DNA damage repair, drug efflux, and anti-apoptotic genes, and reducing cisplatin/5-FU chemosensitivity. The tumor-suppressive adipokine adiponectin promotes M1 macrophage and CD8⁺ effector T cell infiltration, reverses immunosuppression, and sensitizes chemotherapy. This article systematically reviews the origin and classification of adipokines, the polarization patterns of immune cells in the OSCC microenvironment, the molecular pathways by which various adipokines regulate immune polarization, and the complete mechanism by which immune polarization mediates chemotherapy resistance. It summarizes the value of clinical markers and targeted reversal strategies, points out current research bottlenecks, and looks forward to the translational prospects of metabolism-immunotherapy combined with chemotherapy, aiming to provide new metabolism-immune targets for overcoming chemotherapy resistance in oral cancer.</p>","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":"16 ","pages":"1954382"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful conservative management of hepatic portal venous gas complicating severe immune-related gastrointestinal injury during pembrolizumab-based concurrent chemoradiotherapy for cervical cancer: a mechanistic case report.","authors":"Miwa Minamitani, Hideaki Tsuyoshi, Tatsushi Naito, Yasunari Nakamoto, Makoto Orisaka","doi":"10.3389/fonc.2026.1942174","DOIUrl":"10.3389/fonc.2026.1942174","url":null,"abstract":"<p><p>Concurrent chemoradiotherapy (CCRT) combined with pembrolizumab has become the standard treatment for high-risk locally advanced cervical cancer, increasing the need for prompt recognition of immune-related adverse events (irAEs). We report a rare case of severe gastrointestinal irAE complicated by hepatic portal venous gas (HPVG) during pembrolizumab-based CCRT. A 72-year-old woman with FIGO 2018 stage IIIC1r cervical squamous cell carcinoma developed persistent diarrhea and anorexia during treatment, followed by sudden hematemesis after the first brachytherapy session. Upper gastrointestinal endoscopy revealed diffuse gastric mucosal necrosis, while contrast-enhanced computed tomography demonstrated HPVG, intramural gastric gas, and diffuse gastrointestinal wall edema without evidence of intestinal ischemia. Gastric biopsy showed marked intraepithelial lymphocytic infiltration predominantly composed of CD8-positive T cells, consistent with pembrolizumab-induced gastrointestinal irAE. High-dose corticosteroid therapy and supportive conservative management resulted in rapid clinical and radiological resolution, avoiding surgical intervention. This case highlights that gastrointestinal irAEs may mimic conventional CCRT-related toxicities, delaying diagnosis. Furthermore, HPVG should not be considered synonymous with intestinal necrosis. Careful integration of clinical, radiological, endoscopic, and pathological findings is essential to distinguish immune-mediated gastrointestinal injury from ischemic disease and to guide appropriate management.</p>","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":"16 ","pages":"1942174"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophageal carcinoma with ductal differentiation combined with multiple myeloma: a case report.","authors":"Hongjing Sun, Minghao Gao, Xiaohui Feng","doi":"10.3389/fonc.2026.1922758","DOIUrl":"10.3389/fonc.2026.1922758","url":null,"abstract":"<p><p>Esophageal carcinoma with ductal differentiation (ECDD) is a rare esophageal cancer (EC), characterized by distinctive morphological features, including bilayered duct-like structures and a biphenotypic immunophenotype. Multiple myeloma (MM) is a plasma cell neoplasm. The synchronous occurrence of these two entities is exceedingly rare. We report an 80-year-old male who presented with fatigue, anemia, and hypoalbuminemia. Endoscopic examination revealed a high-grade intraepithelial neoplasia of the esophagus. Following endoscopic submucosal dissection, pathological examination confirmed ECDD. Immunohistochemistry demonstrated that the inner layer cells of the duct-like structures were positive for CK7 and CAM5.2, while the outer layer cells were positive for p40 and p63. Concurrently, elevated serum globulin levels prompted further evaluation, leading to a diagnosis of MM. At 13 months postoperatively, no recurrence or metastasis of EC was observed, and the patient's MM remained stable. This case highlights that in elderly patients presenting with hematological abnormalities, the possibility of coexisting solid malignancy and plasma cell dyscrasia should be considered. ECDD has distinctive pathological features, and accurate recognition is critical to avoid misdiagnosis.</p>","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":"16 ","pages":"1922758"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Metastatic duodenal hepatoid adenocarcinoma: a rare pathology with exceptional response to dual immune checkpoint blockade.","authors":"Ranju Gupta, Darshan Lal, Rohit Walia, Shanth Goonewardene, Elizabeth Dellers, Kanchan Gupta","doi":"10.3389/fonc.2026.1896620","DOIUrl":"10.3389/fonc.2026.1896620","url":null,"abstract":"<p><p>Hepatoid adenocarcinoma (HAC) is a rare, malignant, extrahepatic tumor with hepatocellular differentiation. HAC is often associated with elevated serum alpha-fetoprotein (AFP) concentrations, which makes it difficult to distinguish from primary hepatocellular carcinoma (HCC). It is a difficult diagnosis based on histopathology, as the immunohistochemistry (IHC) profile often overlaps with hepatocellular carcinoma. HAC can arise from multiple organs, including the stomach, esophagus, colon, pancreas, duodenum, and peritoneum, with the stomach being the most common site. The treatment of HAC is not well defined, as randomized trial data is not available. The overall prognosis of metastatic HAC with standard combination chemotherapy is extremely poor. Here, we present a case of metastatic duodenal HAC that achieved a sustained complete response to chemotherapy-free dual immune checkpoint blockade, which, to our knowledge, represents the first published report of a sustained complete response to chemotherapy-free dual immune checkpoint blockade in metastatic duodenal HAC and suggests a potential approach that warrants further clinical investigation. We acknowledge that a degree of diagnostic uncertainty remains, as HAC and HCC can exhibit essentially identical morphologic and immunophenotypic features, making the distinction largely clinical.</p>","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":"16 ","pages":"1896620"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potential involvement of a TLR4-associated CD155/TIGIT pathway in <i>Porphyromonas gingivalis</i>-induced immunosuppressive microenvironment formation in oral squamous cell carcinoma.","authors":"Xiao Tian, Liming Xu, Yulian Fu, Qiang Qiang, Xue Cao, Jie Wang, Langqing Liu, Bin Ling","doi":"10.3389/fonc.2026.1773440","DOIUrl":"10.3389/fonc.2026.1773440","url":null,"abstract":"<p><strong>Objective: </strong>Accumulating evidence indicates that oral microbiota dysbiosis and periodontal pathogens contribute to the initiation and progression of oral squamous cell carcinoma (OSCC). However, the molecular mechanisms underlying the interaction between <i>Porphyromonas gingivalis</i> and the tumor immune microenvironment remain incompletely understood. This study aimed to investigate the potential role of a TLR4-associated ERK/CD155/TIGIT signaling pathway in <i>P. gingivalis</i>-mediated immunosuppressive microenvironment formation during OSCC progression.</p><p><strong>Methods: </strong>Genes associated with <i>P. gingivalis</i> and TIGIT were obtained from GeneCards and The Cancer Genome Atlas (TCGA) databases. Candidate hub genes were identified through bioinformatic analyses. An SCC7 syngeneic orthotopic transplantation mouse model was established, and SCC7 cells were injected together with <i>Porphyromonas gingivalis</i>. Tumor growth was assessed by measuring tumor volume and weight. Expression levels of TLR4, ERK1/2, CD155, and TIGIT were evaluated by immunohistochemistry and quantitative real-time PCR (qRT-PCR). Flow cytometry was performed to analyze tumor-infiltrating immune-cell populations. The TLR4 inhibitor TAK-242 was used to investigate the involvement of TLR4-associated signaling.</p><p><strong>Results: </strong>Bioinformatic analysis identified TLR4 as a biologically relevant candidate hub gene potentially linking <i>P. gingivalis</i>-associated signaling and TIGIT-related immune regulation. Exposure to <i>P. gingivalis</i> significantly promoted tumor growth and increased the expression of TLR4, ERK1/2, CD155, and TIGIT in tumor tissues. Flow cytometric analysis revealed immune microenvironment remodeling characterized by increased proportions of CD4+ T cells, TIGIT-positive Tregs, and IL-10-positive cells, accompanied by reduced CD8+ T-cell infiltration and decreased frequencies of Ki67+CD8+ and CD44+CD8+ T cells. Treatment with the TLR4 inhibitor TAK-242 partially reversed these tumor-promoting, immunological, and molecular changes.</p><p><strong>Conclusion: </strong>Our findings suggest that exposure to <i>P. gingivalis</i> may promote OSCC progression by contributing to immune microenvironment remodeling. Increased expression of TLR4, ERK1/2, CD155, and TIGIT, together with the effects of TLR4 inhibition, supports the potential involvement of a TLR4-associated ERK/CD155/TIGIT signaling pathway in this process. However, the precise molecular mechanisms require further validation using genetic and functional approaches.</p>","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":"16 ","pages":"1773440"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative biopsy underestimates tumour budding but retains prognostic value in oral squamous cell carcinoma.","authors":"Janik Riese, Claudio Cacchi, Julia Peppler, Guillaume Bonni, Julia Pannhausen, Anna Klein, Flurin Müller-Diesing, Danny Jonigk, Frank Hölzle, Maurice Klein","doi":"10.3389/fonc.2026.1932265","DOIUrl":"10.3389/fonc.2026.1932265","url":null,"abstract":"<p><strong>Introduction: </strong>Tumour budding is an established prognostic marker in oral squamous cell carcinoma (OSCC), but its reliability and prognostic performance in preoperative biopsy specimens remain uncertain. This study compared tumour budding assessment in matched biopsy and resection specimens and evaluated their respective prognostic value.</p><p><strong>Methods: </strong>We retrospectively analysed 256 patients with OSCC and matched preoperative biopsy and resection specimens. Tumour budding at the invasive front was assessed on hematoxylin and eosin-stained sections according to the International Tumour Budding Consensus Conference criteria and agreement between biopsy- and resection-based assessment was evaluated alongside associations with clinicopathological characteristics, disease-specific survival and occult nodal metastasis using logistic regression and Cox proportional hazards models.</p><p><strong>Results: </strong>Biopsy-derived tumour budding showed only weak correlation with resection findings and systematically underestimated high tumour budding, resulting in poor categorical agreement (κ = 0.11) and low sensitivity (9.8%) despite high specificity (98.9%). Nevertheless, both biopsy- and resection-based tumour budding were associated with disease-specific survival when mutually adjusted for each other. The C-index was numerically higher for resection-based than biopsy-based assessment (0.72 vs. 0.60), with only a modest increase when both measures were combined (C-index 0.74). Both biopsy- and resection-derived tumour budding were also associated with local recurrence and distant metastasis in mutually adjusted Cox models, although these secondary analyses remain exploratory. Interpretation is limited by the small biopsy high-budding group (n = 10) and the limited number of events for several secondary outcomes. For later lymph-node metastasis, only resection-derived tumour budding remained statistically significant after mutual adjustment, whereas the association with biopsy-derived tumour budding was borderline. Resection-derived tumour budding, but not biopsy-derived tumour budding, remained associated with occult nodal metastasis after mutual adjustment, while no statistically significant specimen-type interactions were detected for the evaluated clinicopathological characteristics, with several estimates remaining imprecise.</p><p><strong>Discussion: </strong>Preoperative biopsy-derived tumour budding may provide clinically relevant prognostic information in OSCC despite systematically underestimating high tumour budding. Although resection-based assessment showed a numerically higher C-index, biopsy assessment may provide complementary preoperative prognostic information but should not be considered a surrogate for resection-based assessment.</p>","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":"16 ","pages":"1932265"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preparedness for early detection of oral cancer and oral potentially malignant disorders among Saudi dental students: a multicenter cross-sectional survey.","authors":"Bassel Tarakji, Anas Alsalhani, Faisal Mehsen Alali, Nasser Raqe Alqhtani, Abdullah Saad Alqahtani, Abdullah Bin Nabhan, Abdullah Almansour, Abdulaziz Alrubayyi, Majed Kariri, Mohammed Said Alshahrei, Lina A Alshahrani, Mohammed Alshammari, Rawda Omar Alghabban, Halah Thanoon, Deema Alshammery, Mohammad Zakaria Nassani, Faisal S Alhedyan","doi":"10.3389/fonc.2026.1914773","DOIUrl":"10.3389/fonc.2026.1914773","url":null,"abstract":"<p><strong>Background: </strong>Oral cancer remains a major global health challenge, with delayed diagnosis contributing to poor prognosis and reduced survival. Dental students play an important role in early detection; however, deficiencies in preparedness and diagnostic confidence have been reported. This study assessed oral cancer knowledge, oral potentially malignant disorder (OPMD) awareness, and diagnostic confidence among Saudi dental students.</p><p><strong>Methods: </strong>A quantitative cross-sectional online survey was conducted among 354 dental students and interns from governmental and private dental schools in Saudi Arabia. The questionnaire assessed oral cancer knowledge, OPMD knowledge, and self-reported diagnostic confidence related to screening and biopsy procedures. Participants were classified as meeting or not meeting a study-defined minimum operational threshold of ≥60% of the maximum possible score in each domain; this cutoff was not interpreted as a definition of \"good\" performance or clinical competence. Associations between participant characteristics and study outcomes were examined using chi-square tests and multivariable binary logistic regression analyses.</p><p><strong>Results: </strong>Overall, 81.9% of participants met the oral cancer knowledge threshold, 55.4% met the OPMD knowledge threshold, and 24.0% met the diagnostic confidence threshold. Most participants correctly identified major oral cancer risk factors, including tobacco smoking (97.2%), alcohol consumption (92.7%), and human papillomavirus infection (86.7%). However, clinically oriented response patterns highlighted areas for educational attention. 20.1% selected the prespecified specialist-referral response for management of a persistent suspicious lesion, while 35.6% recognized factors associated with increased malignant transformation risk in leukoplakia. Intern status remained independently associated with meeting the oral cancer knowledge and diagnostic confidence thresholds in multivariable analyses. The diagnostic-confidence outcome reflected self-perceived preparedness rather than observed screening, referral, or procedural competence.</p><p><strong>Conclusion: </strong>A high proportion of Saudi dental students met the study-defined oral cancer knowledge threshold; however, self-reported diagnostic confidence and preparedness for early detection remained considerably lower. Strengthening competency-based oral cancer education and clinical training may improve early detection preparedness and referral practices among future dental practitioners. Because the domains assessed different constructs and had different effective cutoffs, their threshold proportions should not be compared directly; the diagnostic-confidence findings represent perceived preparedness only.</p>","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":"16 ","pages":"1914773"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Novel theragnostic approaches in thoracic malignancies.","authors":"Andrea Cimini, Francesca Russo, Maria Silvia De Feo, Habibollah Dadgar","doi":"10.3389/fonc.2026.2006660","DOIUrl":"https://doi.org/10.3389/fonc.2026.2006660","url":null,"abstract":"","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":"16 ","pages":"2006660"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A biopsy-validated study of combined DL-upscaled MRSI and (18F)-FACBC PET for presurgical glioma diagnosis.","authors":"Erin Beate Bjørkeli, Anna Maria Karlberg, Benedikte Emilie Vindstad, Lars Kjelsberg Pedersen, Ole Skeidsvoll Solheim, Jonn Terje Geitung, Morteza Esmaeili, Live Eikenes","doi":"10.3389/fonc.2026.1968798","DOIUrl":"10.3389/fonc.2026.1968798","url":null,"abstract":"<p><p>Medical imaging is crucial for glioma management. Combined with MRI, amino acid PET may improve glioma diagnosis, biopsy targeting, and tumor delineation compared to structural MRI alone. Magnetic resonance spectroscopic imaging (MRSI) complements both structural MRI and PET by detecting metabolites such as N-acetylaspartate (NAA), creatine (Cr), and choline (Cho), which are markers for brain health and tumor malignancy, but is challenged by low spatial resolution. This study evaluates whether upscaled MRSI enhanced by deep learning can improve diagnostic accuracy and serve as a complement or alternative to PET for glioma classification. Ten glioma patients (ages 24-80) were included. Presurgical [18F]-FACBC PET/MRI, including proton 2D MRSI, was acquired for all patients. Thirty-two image-guided biopsies were sampled during surgery from the patients and classified as glioma tissue or non-tumor tissue, and according to <i>IDH1</i> status. For each biopsy location, tumor-to-background ratio (TBR) and standardized uptake value (SUV) from PET, and tCho/NAA and tCho/tCr ratios from MRSI were calculated. ROC analysis was used to assess the accuracy of [18F]-FACBC PET and upscaled MRSI, and the combinations of these in classifying glioma vs non-tumor tissue and <i>IDH1</i> status. Among the individual biomarkers evaluated, the tCho/NAA ratio from the deep learning-based model demonstrated the highest apparent AUC for classifying glioma vs. non-tumor tissue (AUC = 0.87, 95% CI: 0.66-1.0), compared with tCho/tCr (AUC = 0.81, 95% CI: 0.54-1:00), SUV (AUC = 0.71, 95% CI: 0.49-0.90), and TBR (AUC = 0.68, 95% CI: 0.48-0.86). Combining TBR with tCho/NAA and/or tCho/tCr improved tissue classification compared to either modality alone, where TBR+tCho/NAA+tCho/tCr showed the best results (AUC = 0.91, 95% CI: 0.71-1.0). MRSI was a poor predictor for <i>IDH1</i>-status (tCho/NAA: AUC = 0.67, 95% CI: 0.44-0.88 and tCho/tCr: AUC = 0.38, 95% CI: 0.17-0.60), while PET was an excellent predictor (SUV: AUC = 0.83, 95% CI: 0.66-0.95 and TBR: AUC = 0.82, 95% CI: 0.65-0.94) and the combination of SUV, tCho/NAA, and tCho/tCr was a best predictor (AUC = 0.96, 95% CI: 0.88-1.0). Combining DL-upscaled MRSI with [18F]-FACBC PET appeared to enhance discrimination between glioma and non-tumor tissue, a finding that warrants validation in larger, prospective studies.</p>","PeriodicalId":12482,"journal":{"name":"Frontiers in Oncology","volume":"16 ","pages":"1968798"},"PeriodicalIF":3.4,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13661501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}