Sepúlveda-Méndez Jesús, de Murphy Consuelo Arteaga, Pedraza-López Martha, Murphy-Stack Eduardo, Rojas-Bautista Juan Carlos, González-Treviño Ofelia
Departamento de Medicina Nuclear, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Delegación Tlalpan, México DF, México.
Nucl Med Commun. 2012 Jan;33(1):69-79. doi: 10.1097/MNM.0b013e32834cecfe.
Gastroenteropancreatic neuroendocrine tumors (NETs) are cancers originating from neuroendocrine organs such as the pancreas, pituitary, thyroid, and adrenal glands and tumors arising from the diffuse neuroendocrine cells that are widely distributed throughout the body. NETs express somatostatin (SS) and contain a high density of SS receptors; therefore, they can be specifically targeted with SS-based radiopharmaceuticals. The aim of this research was to determine the validity in terms of specificity, sensitivity, and the agreement beyond chance with the biopsy (gold standard) of the ⁹⁹mTc-EDDA-HYNIC-Tyr³octreotide (⁹⁹mTc-TOC) to image and localize NETs and their metastases.
Freeze-dried kits containing 0.0125 mg HYNIC-octreotide and co-ligands were easily labeled and quality controlled within the hospital radiopharmacy. Fifty-six consecutive Mexican patients with a previous presumptive diagnosis of NETs underwent several clinical and laboratory studies and were referred to the Nuclear Medicine Department for a routine scan with ⁹⁹mTc-TOC. The patients were injected with 500-600 MBq ⁹⁹mTc-TOC, and whole-body images were obtained 2 h later with a SPECT or a SPECT/CT camera. Two nuclear medicine physicians observed the images and classified them as 17 negative and 39 positive. After correlating the image of each patient with our 'gold standard' (biopsy, clinical history, morphological images, and tumor marker assays), the ⁹⁹mTc-TOC images were classified by the same two physicians as 12 true negatives, five false negatives, 38 true positives and one false positive.
The validity of ⁹⁹mTc-TOC in terms of relative frequencies with corresponding 95% confidence intervals were as follows: 92.3% (64-100%) specificity; 88.4% (78-97%) sensitivity; and the agreement beyond chance was 73% (60-84%). The positive predictive value was 97.4% (87-100%); the negative predicted value was 70.6% (48-93%); the accuracy was 89.3% (89-97%); and the prevalence was 76.8% (64-87%).
Because of these high values, we strongly recommend scintigraphy with the Mexican-produced ⁹⁹mTc-TOC for the localization of NETs and their metastases, and we conclude that it is a good tool for detecting neuroendocrine disease in a Mexican population.
胃肠胰神经内分泌肿瘤（NETs）是起源于神经内分泌器官（如胰腺、垂体、甲状腺和肾上腺）的癌症，以及由广泛分布于全身的弥漫性神经内分泌细胞产生的肿瘤。NETs表达生长抑素（SS）并含有高密度的SS受体；因此，它们可以被基于SS的放射性药物特异性靶向。本研究的目的是确定⁹⁹mTc-EDDA-HYNIC-Tyr³奥曲肽（⁹⁹mTc-TOC）在NETs及其转移灶成像和定位方面的特异性、敏感性以及与活检（金标准）的非偶然一致性的有效性。
含有0.0125mg HYNIC-奥曲肽和共配体的冻干试剂盒在医院放射性药房内易于标记和质量控制。56例先前疑似诊断为NETs的墨西哥患者接受了多项临床和实验室检查，并被转诊至核医学科进行⁹⁹mTc-TOC常规扫描。患者注射500 - 600MBq的⁹⁹mTc-TOC，2小时后用SPECT或SPECT/CT相机获取全身图像。两名核医学医师观察图像并将其分类为17例阴性和39例阳性。在将每位患者的图像与我们的“金标准”（活检、临床病史、形态学图像和肿瘤标志物检测）进行关联后，这两名医师将⁹⁹mTc-TOC图像分类为12例真阴性、5例假阴性、38例真阳性和1例假阳性。
⁹⁹mTc-TOC在相对频率方面的有效性及相应的95%置信区间如下：特异性为92.3%（64 - 100%）；敏感性为88.4%（78 - 97%）；非偶然一致性为73%（60 - 84%）。阳性预测值为97.4%（87 - 100%）；阴性预测值为70.6%（48 - 93%）；准确性为89.3%（89 - 97%）；患病率为76.8%（64 - 87%）。
由于这些高值，我们强烈推荐使用墨西哥生产的⁹⁹mTc-TOC进行闪烁扫描以定位NETs及其转移灶，并且我们得出结论，它是检测墨西哥人群神经内分泌疾病的良好工具。
