Division of Nuclear Medicine, Department of Medical Radiology, University Hospital of Zurich, Zurich, Switzerland
Bayer Healthcare AG, Berlin, Germany.
J Nucl Med. 2014 Nov;55(11):1778-85. doi: 10.2967/jnumed.114.140699. Epub 2014 Sep 25.
(D)-(18)F-fluoromethyltyrosine (d-(18)F-FMT), or BAY 86-9596, is a novel (18)F-labeled tyrosine derivative rapidly transported by the l-amino acid transporter (LAT-1), with a faster blood pool clearance than the corresponding l-isomer. The aim of this study was to demonstrate the feasibility of tumor detection in patients with non-small cell lung cancer (NSCLC) or head and neck squamous cell cancer (HNSCC) compared with inflammatory and physiologic tissues in direct comparison to (18)F-FDG.
18 patients with biopsy-proven NSCLC (n = 10) or HNSCC (n = 8) were included in this Institutional Review Board-approved, prospective multicenter study. All patients underwent (18)F-FDG PET/CT scans within 21 d before d-(18)F-FMT PET/CT. For all patients, safety and outcome data were assessed.
No adverse reactions were observed related to d-(18)F-FMT. Fifty-two lesions were (18)F-FDG-positive, and 42 of those were malignant (34 histologically proven and 8 with clinical reference). Thirty-two of the 42 malignant lesions were also d-(18)F-FMT-positive, and 10 lesions had no tracer uptake above the level of the blood pool. Overall there were 34 true-positive, 8 true-negative, 10 false-negative, and only 2 false-positive lesions for d-(18)F-FMT, whereas (18)F-FDG was true-positive in 42 lesions, with 10 false-positive and only 2 false-negative, resulting in a lesion-based detection rate for d-(18)F-FMT and (18)F-FDG of 77% and 95%, respectively, with an accuracy of 78% for both tracers. A high d-(18)F-FMT tumor-to-blood pool ratio had a negative correlation with overall survival (P = 0.050), whereas the (18)F-FDG tumor-to-blood pool ratio did not correlate with overall survival.
d-(18)F-FMT imaging in patients with NSCLC and HNSCC is safe and feasible. The presented preliminary results suggest a lower sensitivity but higher specificity for d-(18)F-FMT over (18)F-FDG, since there is no d-(18)F-FMT uptake in inflammation. This increased specificity may be particularly beneficial in areas with endemic granulomatous disease and may improve clinical management. Further clinical investigations are needed to determine its clinical value and relevance for the prediction of survival prognosis.
与（18）F-FDG 相比，直接比较非小细胞肺癌（NSCLC）或头颈部鳞状细胞癌（HNSCC）患者的炎症和生理组织，证明（D）-（18）F-氟甲基酪氨酸（d-（18）F-FMT）或 BAY 86-9596 作为新型（18）F 标记的酪氨酸衍生物检测肿瘤的可行性。方法：本机构审查委员会批准的前瞻性多中心研究纳入了 18 名经活检证实的 NSCLC（n=10）或 HNSCC（n=8）患者。所有患者均在 d-（18）F-FMT PET/CT 检查前 21 天内接受（18）F-FDG PET/CT 检查。对所有患者进行安全性和结局数据评估。结果：未观察到与 d-（18）F-FMT 相关的不良反应。52 个病灶（18）F-FDG 阳性，其中 42 个为恶性（34 个组织学证实，8 个有临床参考）。42 个恶性病灶中有 32 个为 d-（18）F-FMT 阳性，10 个病灶的摄取水平高于血池。总体而言，d-（18）F-FMT 有 34 个真阳性、8 个真阴性、10 个假阴性和 2 个假阳性病灶，而（18）F-FDG 在 42 个病灶中为真阳性，有 10 个假阳性和仅 2 个假阴性，导致 d-（18）F-FMT 和（18）F-FDG 的病灶检出率分别为 77%和 95%，两种示踪剂的准确率均为 78%。高 d-（18）F-FMT 肿瘤/血池比与总生存时间呈负相关（P=0.050），而（18）F-FDG 肿瘤/血池比与总生存时间无相关性。结论：在 NSCLC 和 HNSCC 患者中，d-（18）F-FMT 成像安全可行。初步结果表明，d-（18）F-FMT 的敏感性低于（18）F-FDG，但特异性高于（18）F-FDG，因为炎症部位没有 d-（18）F-FMT 摄取。这种特异性的提高在地方性肉芽肿性疾病的地区可能特别有益，并可能改善临床管理。需要进一步的临床研究来确定其临床价值和对生存预后预测的相关性。
