Börjesson Pontus K E, Jauw Yvonne W S, Boellaard Ronald, de Bree Remco, Comans Emile F I, Roos Jan C, Castelijns Jonas A, Vosjan Maria J W D, Kummer J Alain, Leemans C René, Lammertsma Adriaan A, van Dongen Guus A M S
Department of Otolaryngology/Head and Neck Surgery, Nuclear Medicine and Positron Emission Tomography Research, Radiology, Amsterdam, The Netherlands.
Clin Cancer Res. 2006 Apr 1;12(7 Pt 1):2133-40. doi: 10.1158/1078-0432.CCR-05-2137.
Immuno-positron emission tomography (PET), the combination of PET with monoclonal antibodies (mAb), is an attractive option to improve tumor detection and to guide mAb-based therapy. The long-lived positron emitter zirconium-89 ((89)Zr) has ideal physical characteristics for immuno-PET with intact mAbs but has never been used in a clinical setting. In the present feasibility study, we aimed to evaluate the diagnostic imaging performance of immuno-PET with (89)Zr-labeled-chimeric mAb (cmAb) U36 in patients with squamous cell carcinoma of the head and neck (HNSCC), who were at high risk of having neck lymph node metastases.
Twenty HNSCC patients, scheduled to undergo neck dissection with or without resection of the primary tumor, received 75 MBq (89)Zr coupled to the anti-CD44v6 cmAb U36 (10 mg). All patients were examined by computed tomography (CT) and/or magnetic resonance imaging (MRI) and immuno-PET before surgery. Six patients also underwent PET with (18)F-fluoro-2-deoxy-d-glucose. Immuno-PET scans were acquired up to 144 hours after injection. Diagnostic findings were recorded per neck side (left or right) as well as per lymph node level (six levels per side), and compared with histopathologic outcome. For this purpose, the CT/MRI scores were combined and the best of both scores was used for analysis.
Immuno-PET detected all primary tumors (n = 17) as well as lymph node metastases in 18 of 25 positive levels (sensitivity 72%) and in 11 of 15 positive sides (sensitivity 73%). Interpretation of immuno-PET was correct in 112 of 121 operated levels (accuracy 93%) and in 19 of 25 operated sides (accuracy 76%). For CT/MRI, sensitivities of 60% and 73% and accuracies of 90% and 80% were found per level and side, respectively. In the six patients with seven tumor-involved neck levels and sides, immuno-PET and (18)F-fluoro-2-deoxy-d-glucose PET gave comparable diagnostic results.
In this study, immuno-PET with (89)Zr-cmAb U36 performed at least as good as CT/MRI for detection of HNSCC lymph node metastases.
免疫正电子发射断层扫描（PET），即PET与单克隆抗体（mAb）的结合，是改善肿瘤检测及指导基于mAb治疗的一种有吸引力的选择。长寿命正电子发射体锆-89（89Zr）具有与完整mAb进行免疫PET的理想物理特性，但从未用于临床。在本可行性研究中，我们旨在评估用89Zr标记的嵌合单克隆抗体（cmAb）U36对有颈部淋巴结转移高风险的头颈部鳞状细胞癌（HNSCC）患者进行免疫PET的诊断成像性能。
20例计划接受颈部清扫术（伴或不伴原发肿瘤切除）的HNSCC患者，接受了与抗CD44v6 cmAb U36（10 mg）偶联的75 MBq 89Zr。所有患者在手术前均接受计算机断层扫描（CT）和/或磁共振成像（MRI）以及免疫PET检查。6例患者还接受了18F-氟-2-脱氧-D-葡萄糖PET检查。免疫PET扫描在注射后长达144小时进行。按颈部每一侧（左侧或右侧）以及每一个淋巴结水平（每侧六个水平）记录诊断结果，并与组织病理学结果进行比较。为此，将CT/MRI评分合并，并采用两者中的最佳评分进行分析。
免疫PET检测到了所有原发肿瘤（n = 17）以及25个阳性水平中的18个（敏感性72%）和15个阳性侧中的11个（敏感性73%）的淋巴结转移。在121个手术水平中的112个（准确性93%）和25个手术侧中的19个（准确性76%），免疫PET的解读是正确的。对于CT/MRI，每水平和每侧的敏感性分别为60%和73%，准确性分别为90%和80%。在7个肿瘤累及颈部水平和侧的6例患者中，免疫PET和18F-氟-2-脱氧-D-葡萄糖PET给出了相当的诊断结果。
在本研究中，用89Zr-cmAb U36进行免疫PET在检测HNSCC淋巴结转移方面的表现至少与CT/MRI一样好。
