Ferran Nuria, Ricart Yvonne, Lopez Marta, Martinez-Ballarin Ignacio, Roca Manel, Gámez Cristina, Carrerea David, Guirao Sara, Leon Alejandro Fernandez, Martin-Comin Jose
Hospitalet de Llobregat, Hospital Universitari de Bellvitge-Idibell, Spain.
Nucl Med Commun. 2006 Jun;27(6):507-14. doi: 10.1097/00006231-200606000-00006.
To evaluate the diagnostic accuracy of 99m Tc-depreotide vs PET-18FDG scans in patients with suspicion of lung cancer.
Prospective study in 29 patients (age: 38-80 years) diagnosed of inderteminate lung lesions. Diagnosis was established by histology based on samples of surgical resection, fine needle aspiration (FNA) or broncoalveolar lavage (BAL). Within a maximum of 10 days, without pre-established fixed order the following exams were performed: 1) Whole body and chest SPECT-CT with Tc-depreótide (DEP-SPECT) and 2) PET-CT study with F-FDG (PET-FDG). Every exam was evaluated by Nuclear Medicine especialist blinded to patient data.
Malignancy was confirmed in 20 patients. PET-FDG was positive in all cases. DEP-SPECT was positive in 17 and falselly negative in 3, one carcinoid tumor, one undifferentiated non-small cell adenocarcinoma, and a moderately differentiated adenocarcinoma. In the remaining 9 patients benignancy was confirmed; both studies were normal in 8 and falselly positive in one case of non-specific inflammatory lung process. In 9 out of the 20 cases with malignancy extrapulmonar uptake was seen, with a total number of 19 lesions. In two cases the extrapulmonar uptake were non ganglionar metastasis (bone and adrenal) and in 7 due to mediastinic ganglionar involvement. ROC analysis using peak SUV FDG (cut-off point of 3.5) uptake and target/background depreotide uptake (cut-off point of 1.3) provided, sensitivity and specificity values of 95% and 89% of 84% and 88% for PET and SPECT respectively. It does not exist statistically significant differences between both methods (Z-test SPSS). In summary, FDG-PET has a greater sensitivity and diagnostic accuracy for assessing malignancy of indeterminate lung lesions, and for detection of extrapulmonary involvement, DEP-SPECT represents a good diagnostic alternative for centers where PET is not available.
评估⁹⁹ᵐTc- Depreotide与PET-¹⁸FDG扫描对疑似肺癌患者的诊断准确性。
对29例（年龄38 - 80岁）诊断为肺内病变不明确的患者进行前瞻性研究。诊断通过基于手术切除样本、细针穿刺活检（FNA）或支气管肺泡灌洗（BAL）的组织学检查确定。在最多10天内，不按预先设定的固定顺序进行以下检查：1）使用Tc-Depreotide的全身及胸部SPECT-CT（DEP-SPECT）和2）使用F-FDG的PET-CT研究（PET-FDG）。每项检查均由对患者数据不知情的核医学专家进行评估。
20例患者确诊为恶性肿瘤。PET-FDG在所有病例中均为阳性。DEP-SPECT在17例中为阳性，3例为假阴性，分别为1例类癌肿瘤、1例未分化非小细胞腺癌和1例中分化腺癌。其余9例患者确诊为良性病变；8例两项检查均正常，1例非特异性肺部炎症过程为假阳性。20例恶性肿瘤患者中有9例可见肺外摄取，共19个病灶。2例肺外摄取为非神经节转移（骨和肾上腺），7例为纵隔神经节受累。使用SUVmax FDG（截断点为3.5）摄取和靶/本底Depreotide摄取（截断点为1.3）进行ROC分析，PET和SPECT的敏感性和特异性值分别为95%和89%以及84%和88%。两种方法之间不存在统计学显著差异（SPSS的Z检验）。总之，FDG-PET在评估肺内病变不明确的恶性肿瘤方面具有更高的敏感性和诊断准确性，对于检测肺外受累情况，DEP-SPECT是PET不可用时的一种良好诊断替代方法。
