
New Radiotracer Can Identify Nearly 30 Types of Cancer - howard941
https://www.snmmi.org/NewsPublications/NewsDetail.aspx?ItemNumber=31744
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Randypea
I was diagnosed with NET cancer recently and my doctor incorrectly ordered the
older radiotracer scan. It only showed 1/2 of my tumors, missing the most
important primary tumor. This newer scan/radiotracer showed double the number
of tumors including the most important step of finding the primary. I will
soon have cytoreduction surgery to remove the tumors. Unless you have other
biomarkers showing cancer, the issue for this scan is cost - $2-5K. You would
not do it casually. Contact me if you want to see a side by side comparison of
this new scan beside an older one.

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lipman
Thanks for sharing. You got FDG PET ("older") as well as FAPI? Are you in the
US? Curious if FAPI is already in wide use.... does FDG not work that well for
NET ?

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Randypea
I am in the US and FDG PET does not work for NET. The "older" scan was Pet
radiolabeled with indium-111. Comparison is here:
[http://prntscr.com/o02jsg](http://prntscr.com/o02jsg) Left is the newer scan,
which uses Gallium 68. The primary tumor is uppermost right side, liver
metastasis is left side, and small lower lighted up areas are lymph nodes. All
will be removed soon. Lit up area below is the radiotracer in my bladder
before urinating. :-)

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tecleandor
Wow! Do you have DICOM files for that! Good thing they found all that! Good
luck with all the surgery, you'll get better soon!

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Randypea
Yes I have all the Dicom files and put all the images on a password protected
server so I can share with prospective surgeons. This really helped me find
the best possible surgeon. THANKS!

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salgernon
Minor side note: I did that too but found that institutions were locked down
and could not access my public server, and they wouldn’t accept a usb drive
with the same data. They were only set up to receive FAT dvds - and I spent
many, many hours duping DVD’s for doctors in their waiting rooms.

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tecleandor
The USB thing might be a security policy in action. The DVD (and that's weird,
because I think I've never seen DVDs, but lots of CDRs) is probably a
historical thing related to the DICOM Supplement 19 General Purpose CD-R Image
Interchange Profile standard.

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legohead
Anyone have any experience getting tested for cancer when marked as "healthy"?
I contacted my PCP and some other random places asking to get a cancer
screening and nobody would give me the time of day - "that's not done".

At most they said they would do a blood test which checks for a couple types
of cancer. I asked if I could get a CT and have a professional go over it.
nope. But something like this tracer is what I'd like to do.

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nkrumm
MD here. It's "not done" because it could hurt you.

Here's the Bayesian argument:

\- Let's assume a lab test (or imaging test) has a 1% false positive rate and
100% sensitivity (that would be pretty good for many tests and imaging
modalities!).

\- The cancer you screening for has a 1% incidence as well (low-ish, for the
sake of argument).

\- Therefore the chance that a "positive" scan would be due to a false
positive or a true cancer would be equivalent (i.e., the Positive Predictive
Value is 50%).

If we did this at population level, we'd be massively overtreating and over-
biopsy-ing... not the desired outcome.

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docker_up
Maybe figure out a better way to verify that doesn't require biopsy? Maybe use
machine learning in conjunction with better data? I don't know enough but
there must be other techniques we could devise that don't require major
invasive surgery every single time.

Just sitting on our hands on this information and letting people die is the
worst decision. We need to improve our technology to get better results, not
throw our hands up in the air and say the problem is too hard.

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Nasrudith
Well the ways that don't involve surgery are themselves less accurate
heuristics with false positives. How can they calibrate without being certain
if it is a true or false positive or negative?

Better imaging is an option but that often falls into dangerous in itself or
easier said than done like say trying to do detection of cancer by scent.

Machine learning is fundamentally GIGO and tends to learn smartass shortcuts
if one isn't careful. "The healthy sample data is less zoomed in while the
cancer ones are zoomed in - therefore full chest x-ray is fine but a lung
X-ray is cancer."

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Gibbon1
My limited experience is that for small contained cancers imaging can't
predict the future course for the tumor because you need cellar resolution
that you can't get without a biopsy and a microscope and or genetic tests.

Even then it's really common to see a biopsy come back as 'indeterminate'. If
it's indeterminate then now what? You either punt and do nothing or go for
excision.

Consider this tidbit: A lot of slow moving low grade cancers it hardly matters
when you find them. Early or later matters little. Whereas aggressive cancers
often are untreatable. Find them early, find them late you'll die either way.
And fast growing cancers often fully develop between screenings.

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sheeshkebab
In other words - you’re dead either way - go have a beer instead?

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hsavit1
Have been chatting with a radiation oncologist about this. His response:
"imaging appears to be the same as F18-FDG-based PET. Just a bit more
convenient since the patient doesn't need a normal blood sugar. And prob 2-10x
the price"

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sllrp
The great advantage of these tracers is that they target actual structures
over-expressed in cancers, which means they show far higher specificity than
something like FDG. That means they can be used to find micrometastases, and
with a different radio-label also be applied for highly targeted radiation
therapy.

Source: I used to work in the Heidelberg lab that published this study.

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Jolter
That CT image of the breast cancer patient... Ouch. Not easy to look at.

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steve_adams_86
This happened to my mom when she had breast cancer. I wonder if this is a
normal progression with that type of cancer? I have no idea why they did it,
but they did do an autopsy when she died and her doctor basically said she was
riddled with tumours throughout her entire body (she lived 7 years with cancer
after diagnosis, who knows how long before). When I saw these images that's
immediately what I thought of. It's very unsettling.

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childintime
Really impressive images with apparently regular PET-scans, so could be
available for general use rather quickly. It's advances like this that enable
medicine.

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Ice_cream_suit
Classic example of marketing to the naive ....

