Anton Sebastian Becker

Immune checkpoint inhibitors (ICI) have transformed the treatment of advanced non–small cell lung cancer (NSCLC), yet a large proportion of patients do not respond. The lung microbiome is a key modulator of antitumor immunity; however, the functional contribution of active microbial communities and their interaction with host transcriptional programs in shaping ICI outcomes remain poorly defined. In this study, we prospectively analyzed bronchoalveolar lavage (BAL) samples from 71 patients with NSCLC prior to ICI initiation. We profiled the microbiome and host transcriptome in the BAL to look for microbial and host signatures in the lower airways associated with treatment response. We found that enrichment of the lower airway microbiome with oral commensals was associated with disease progression and worse prognosis of patients treated with ICIs. Metatranscriptomics-derived microbial clustering revealed distinct functional profiles. The microbial cluster enriched with oral commensals, which was only present among patients with poor response to ICIs, had differential regulation of pathways involved in the metabolism of short-chain fatty acids, methane, and pyruvate. This cluster also correlated with host immune pathways including upregulation of interferon signaling, neutrophil degranulation, and mitophagy, all of which could contribute to the poor response to immunotherapy. In a preclinical murine model of lung cancer with dysbiosis, inoculating lung tumor–bearing mice with oral commensals increased intratumoral neutrophils and Th17 responses and impaired ICI efficacy. Our findings support the concept that microbial communities in the lower airways influence tumor–immune interactions via defined metabolic–immune axes. Significance: Transcriptionally active lower airway microbial communities are linked clinically and preclinically to immunotherapy response in NSCLC, identifying microbial activity as a functional interface with the tumor microenvironment and a potential therapeutic target.

Purpose: Metastatic spread of cancer to transplanted organs is rare, with no prior systematic review. As both the number of transplant recipients and their long term survival increase, such cases may become more common. This systematic review seeks to synthesize all existing case studies describing metastases in transplanted organs. Methods: A systematic search of EMBASE and PUBMED was conducted following PRISMA guidelines (PROSPERO: CRD420251119412). Eligible studies described cancer originating from the graft recipient metastasizing to a transplant organ. Studies were summarized across six key domains: patient characteristics, primary tumor types, transplant history, imaging, metastatic cancer treatment, and complications and mortality. Results: Of the 643 studies identified and screened, 12 met the inclusion criteria. The mean patient age was 58 years (±11 years). Affected organs included the liver ( n = 7), kidney ( n = 4), and lung ( n = 1). The most common primary cancer was colorectal cancer. Immunosuppression regimens most often included tacrolimus or cyclosporine. Most studies used CT ( n = 6) as the imaging modality to detect metastases. Due to the high prevalence of colorectal cancers, the most common therapy administered was chemotherapy consisting of 5‐fluorouracil, oxaliplatin, and folinic acid. Three studies reported complications and seven reported patients passing away. Conclusion: Metastatic spread to transplanted organs is extremely rare and/or under‐reported. Further research may help reveal more about the process of metastatic spread, guide screening, and standardize reporting.

Purpose of the Report: To determine the prevalence, etiology, and clinical significance of incidental focal small bowel FDG uptake in patients undergoing PET/CT for staging of non-small bowel cancers. Material and Methods: Retrospective review of consecutive FDG PET/CT examinations obtained for cancer staging with incidental focal small bowel radiotracer uptake was performed. Exclusion criteria included known small bowel pathology or insufficient reference standard. Imaging findings assessed included lesion location, number, CT correlate, SUV _max , and presence of metastases outside the bowel. Clinical data included age, sex, cancer clinical setting, origin, and stage. Focal small bowel FDG uptake etiology (benign vs. metastatic) was determined by composite reference standard (histopathology, clinical, and imaging follow-up). Statistical analyses included Wilcoxon rank-sum test, Pearson’s χ ² test, Fisher exact test, and ROC curve analyses. Results: In a review of 147,516 PET/CT examinations, incidental focal small bowel FDG uptake was rare, with a prevalence of 0.1% (88/147,516). Most cases were metastatic, 60.2% (53/88), most commonly spread from lymphoma [32.1% (17/53)] and melanoma [30.2% (16/53)]. Metastatic lesions were evenly distributed throughout the ileum [47.2% (25/53)] and jejunum [39.6% (21/53)]. Metastatic focal small bowel FDG uptake was associated with presence of other sites of distant metastases, higher SUV _max , and presence of a CT correlate ( P <0.01). Conclusions: Incidental focal small bowel FDG uptake is rare. Most small bowel hypermetabolic foci are metastatic and are predominantly encountered with melanoma and lymphoma. Multiple imaging and clinical factors helped differentiate between benign and metastatic focal small bowel FDG uptake.

Objective To develop a tool for the clinical hybrid imaging workflow which combines morphologic and functional measurements. And to quantify the number of clicks saved per positron emission tomography/computed tomography (PET/CT) interpretation. Methods A tool was developed where a volume of interest (VOI) is automatically created around line distance measurements. VOI statistics for both PET and CT component, and line distances are generated and displayed. Usage data for the first two months after introduction of the tool was analyzed. Results Eleven radiologists and nuclear medicine physicians used the tool in 364 PET/CTs. In 19% of examinations, the novel tool was the only tool that needed to be used. The novel combined tool was used 1001 times, whereas the traditional spherical VOI had been placed 1131 times. The usage ratio of new to traditional tool differed significantly between examinations with ≤ 6 annotations (ratio 1.0) versus > 6 annotations (ratio 0.63, p = 0.030). The average number of saved clicks per PET/CT was estimated at 16.5. Conclusion A novel combined measurement tool for hybrid imaging was implemented and saved on average 16.5 clicks per examination. These improvements contribute to a smoother workflow and demonstrate the positive impact of thoughtful software design in medical practice.

Hereditary renal cell carcinoma (RCC) accounts for approximately 5–8% of all renal cancers. This review provides a comprehensive overview of the seven hereditary RCC syndromes recognized by the National Comprehensive Cancer Network: Tuberous Sclerosis Complex (TSC), Von Hippel-Lindau (VHL), Hereditary Leiomyomatosis and Renal Cell Cancer (HLRCC), Hereditary Papillary Renal Carcinoma (HPRC), Birt-Hogg-Dubé syndrome (BHDS), Succinate dehydrogenase (SDH)-deficient RCC/Hereditary Paraganglioma/Pheochromocytoma (PGL/PCC) syndrome, and BAP1 tumor predisposition syndrome (BAP1-TPDS). For each syndrome, the underlying inheritance, epidemiology, and clinicopathologic features of their associated RCCs are detailed. Furthermore, radiographic challenges faced in the diagnosis of RCC in some of these syndromes are discussed, including differentiating RCC from the more common lipid-poor AML in TSC, distinguishing papillary RCC from hemorrhagic cysts in HPRC, and discerning chromophobe RCC from oncocytomas in BHDS. Radiologists are integral to the multidisciplinary management of hereditary RCC, as they are often the first to identify clinicopathologic features suggestive of an underlying genetic syndrome. Recognizing these patterns is crucial for prompting timely genetic evaluation, guiding decisions for nephron-sparing interventions, and establishing appropriate surveillance for patients and their at-risk family members. Advances in radiogenomics and artificial intelligence hold promise for further refining non-invasive diagnosis and personalizing patient care.

In 111 prostate-specific membrane antigen PET/CT reports from 42 U.S. institutions, there was substantial heterogeneity in length, content, structure, and readability as well as underutilization of standardized scoring systems and interpretation frameworks.

Supplementary Table S2: Taxonomic differential abundance between tumor and lung samples