Płachcińska Anna, Mikołajczak Renata, Maecke Helmut R, Michalski Andrzej, Rzeszutek Katarzyna, Kozak Józef, Kuśmierek Jacek
Department of Nuclear Medicine, Medical University, Łódź, Poland.
Eur J Nucl Med Mol Imaging. 2004 Jul;31(7):1005-10. doi: 10.1007/s00259-004-1511-3. Epub 2004 Mar 17.
Forty-three consecutive patients with solitary pulmonary nodules (SPNs) on chest radiographs were studied scintigraphically after administration of the somatostatin analogue (99m)Tc-EDDA/HYNIC-TOC. The objective of the study was to assess the usefulness of the procedure for differentiation of SPNs as malignant or benign. The administered activity was 740-925 MBq, and a single-photon emission computed tomography imaging technique was employed. Verification of the nodule aetiology was based on histology or cytology and bacteriology. A stable tumour size on chest radiography for at least 3 years was accepted as an additional criterion of benignity. In 29 patients, nodules were found to be malignant. The diagnoses included ten adenocarcinomas, five squamous cell carcinomas, two large cell carcinomas, six non-small cell lung cancers without specification of the more detailed morphology, two small cell lung cancers, two typical carcinoids and two metastatic tumours (leiomyosarcoma and malignant melanoma). In 14 patients the following benign tumours were diagnosed: four tuberculomas, one other granuloma, three hamartomas, one non-specific inflammatory infiltrate, one abscess, one peripheral carcinoid with the morphological characteristics of a benign tumour, one ectopic lesion of thyroid tissue and two benign tumours of unspecified aetiology with a stable size over 3 and 5 years respectively. Positive scintigraphic results were obtained in 26 of the 29 patients (90%) with malignant SPNs; among these, 24 of the 25 (96%) cases of primary pulmonary carcinoma yielded positive results. The remaining two false negative cases were the metastatic tumours, liposarcoma and melanoma. Of the 14 benign lesions, ten (71%) did not accumulate the radiopharmaceutical. The remaining four benign tumours that were visible on scintigrams comprised one tuberculoma, one hamartoma, one abscess and one case in which the diagnosis could not be established (the tumour had a stable size over 3 years). In conclusion, scintigraphy with (99m)Tc-EDDA/HYNIC-TOC appears to be an effective procedure for differentiation between malignant and benign SPNs. A fully credible assessment of the clinical efficacy of this procedure requires further study in a larger number of patients.
对43例胸部X线片显示有孤立性肺结节（SPN）的连续患者，在给予生长抑素类似物（99m）Tc - EDDA/HYNIC - TOC后进行了闪烁扫描研究。本研究的目的是评估该检查方法对鉴别SPN为恶性或良性的有用性。给药活度为740 - 925MBq，并采用单光子发射计算机断层扫描成像技术。结节病因的确诊基于组织学、细胞学及细菌学检查。胸部X线片上肿瘤大小至少3年稳定被作为良性的附加标准。29例患者的结节被发现为恶性。诊断包括10例腺癌、5例鳞状细胞癌、2例大细胞癌、6例未明确更详细形态的非小细胞肺癌、2例小细胞肺癌、2例典型类癌和2例转移瘤（平滑肌肉瘤和恶性黑色素瘤）。14例患者被诊断为以下良性肿瘤：有4例结核瘤、1例其他肉芽肿、3例错构瘤、1例非特异性炎性浸润、1例脓肿、1例具有良性肿瘤形态特征的外周类癌、1例甲状腺组织异位病变以及2例病因不明的良性肿瘤，其大小分别在3年和5年以上保持稳定。29例恶性SPN患者中有26例（90%）闪烁扫描结果为阳性；其中，25例原发性肺癌中有24例（96%）结果为阳性。其余2例假阴性病例为转移瘤（脂肪肉瘤和黑色素瘤）。14例良性病变中，10例（71%）未摄取放射性药物。闪烁扫描图上可见的其余4例良性肿瘤包括1例结核瘤、1例错构瘤、1例脓肿和1例诊断未明确的病例（该肿瘤大小在3年以上保持稳定）。总之，（99m）Tc - EDDA/HYNIC - TOC闪烁扫描似乎是鉴别恶性和良性SPN的有效方法。对该检查方法临床疗效的全面可靠评估需要在更多患者中进一步研究。
