协和医学杂志

2016, (05)

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整合素受体显像99mTc-3PRGD2 SPECT/CT用于非小细胞肺癌诊断及淋巴结分期的价值
Integrin Receptor Imaging 99mTc-3PRGD2 SPECT/CT in Diagnosis and Lymph Node Staging of Non Small Cell Lung Cancer

靳晓娜;梁乃新;王孟昭;贾兵;石希敏;李单青;李方;王凡;朱朝晖

摘要(Abstract):

目的 通过与18FFDG PET/CT比较,前瞻性评估整合素αvβ3受体显像99mTc3PRGD2 SPECT/CT对非小细胞肺癌诊断及淋巴结分期的价值。方法 前瞻性纳入2011年2月至2012年12月北京协和医院知情同意参与研究的65例肺占位病变患者。其中男41例,女24例,平均年龄(60±11)岁。患者在1周内分别行99mTc3PRGD2 SPECT/CT和18FFDG PET/CT检查。完成病理诊断后,随访至死亡或随访至少2年。用受试者工作特征曲线、Z检验、卡方检验比较两种方法对肺内病灶及纵隔淋巴结的诊断效能。结果 53例患者共65个病灶经病理证实为非小细胞肺癌,12例患者共14个病灶诊断为良性病变。基于美国癌症联合委员会/国际抗癌联盟纵隔分区,248个区域有肿瘤转移淋巴结,56个区域有良性淋巴结。在诊断纵隔淋巴结转移方面,99mTc3PRGD2 SPECT/CT特异性显著高于18FFDG PET/CT(94.6%比75.0%, P=0.008),而两者的敏感性差异无统计学意义(88.3%比90.7%, P=0.557)。两种方法对肺内病变的诊断效能差异无统计学意义(Z=0.82, P=0.410)。结论 整合素受体显像99mTc3PRGD2 SPECT/CT在诊断淋巴结转移方面具有较高的特异性,可能弥补18FFDG PET/CT的不足,在肺癌手术决策方面具有更大价值。
Objective To prospectively evaluate the value of integrin αvβ3 receptor imaging approach basedon single photon emission computed tomography/computed tomography (SPECT/CT), using 99mTc3PRGD2 as the tracer, in diagnosis and staging of nonsmall cell lung cancer (NSCLC) compared with 18FFDG positron emisson tomography/computed tomography(PET/CT). Methods From February 2011 to December 2012, 65 patients with suspicious lung lesions were recruited with informed consent in Peking Union Medical College Hospital, including 41 males and 24 females, with a mean age of (60±11) years. The patients underwent both 99mTc3PRGD2 SPECT/CT and 18FFDG PET/CT within one week. After pathological diagnosis, all the patients were followed up until death or for at least two years. Receiver operating characteristic (ROC) curve, Z test, and Chisquare test were used to compare the diagnostic performance of the two imaging methods in assessing lung lesions and mediastinal lymph nodes. Results Sixtyfive lung lesions in 53 patients were pathologically diagnosed as NSCLC, and 14 lung lesions in 12 patients were proved as benign. Based on the American Joint Committee on Cancer/Union for International Cancer Control(AJCCUICC) standard, 248 regions of lymph nodes had metastasis and 56 were negative regions. 99mTc3PRGD2 SPECT/CT was found to have higher specificity compared with 18FFDG PET/CT in the perregion diagnosis of lymph node metastasis (94.6% vs. 75.0%, P=0.008), whereas the sensitivity of the two methods showed no statistically significant difference (88.3% vs. 90.7%, P=0.557). There was no significant difference between the two methods in diagnostic performance for lung lesion (Z=0.82, P=0.410). Conclusion 99mTc3PRGD2 SPECT/CT shows high specificity in the diagnosis of lymph node metastasis from NSCLC, which may complement 18FFDG PET/CT in diagnosis and benefit surgical decisionmaking for patients with lung cancer.

关键词(KeyWords): |整合素αvβ3|单光子发射计算机断层成像术|非小细胞肺癌|淋巴结转移|

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基金项目(Foundation): 99mTc-3PRGD2 SPECT显像用于评价肺癌抗新生血管药物疗效的动物研究及肺癌诊断临床研究;新型整合素受体68Ga-NOTA-PRGD2 PETCT在肺癌临床应用的标准化操作技术规范及前瞻性队列研究;新型整合素受体显像剂68Ga-PRGD2在肺癌鉴别诊断及淋巴结转移评估中价值的转化医学研究

作者(Author): 靳晓娜;梁乃新;王孟昭;贾兵;石希敏;李单青;李方;王凡;朱朝晖

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