From the *Unit of Thoracic Surgery, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia; †Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore; ‡Unit of Thoracic Surgery, Azienda Ospedaliera San Camillo Forlanini; and §Institute of Hygiene, Università Cattolica del Sacro Cuore, Rome; ∥Department of Nuclear Medicine, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia; ¶Unit of Pathology, Azienda Ospedaliera San Camillo Forlanini, Rome; #Unit of Pathology, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia; **Department of Thoracic Surgery, and ††Institute of Pathology, Università Cattolica del Sacro Cuore, Rome, Italy.
Clin Nucl Med. 2015 Mar;40(3):e183-9. doi: 10.1097/RLU.0000000000000641.
The aims of this study were to retrospectively evaluate and compare the detection rate (DR) of 68Ga-DOTA-peptide and 18F-FDG PET/CT in the preoperative workup of patients with pulmonary carcinoid (PC) and to assess the utility of various functional indices obtained with the 2 tracers in predicting the histological characterization of PC, that is, typical versus atypical.
Thirty-three consecutive patients with confirmed PC referred for 18F-FDG and 68Ga-DOTA-peptide PET/CT in 2 centers between January 2009 and April 2013 were included. The semiquantitative evaluation included the SUV max, the SUV of the tumor relative to the maximal liver uptake for 18F-FDG (SUV T/L) or the maximal spleen uptake for 68Ga-DOTA-peptides (SUV T/S), the ratio between SUV max of 68Ga-DOTA-peptides PET/CT, and the SUV max of 18F-FDG PET/CT (SUV max ratio). Histology was used as reference standard.
Definitive diagnosis consisted of 23 typical carcinoids (TCs) and 10 atypical carcinoids. 18F-FDG PET/CT was positive in 18 cases and negative in 15 (55% DR). 68Ga-DOTA-peptide PET/CT was positive in 26 cases and negative in 7 (79% DR). In the subgroup analysis, 68Ga-DOTA-peptide PET/CT was superior in detecting TC (91% DR; P < 0.001), whereas 18F-FDG PET/CT was superior in detecting atypical carcinoid (100% DR; P = 0.04). The SUV max ratio was the most accurate semiquantitative index in identifying TC.
Overall diagnostic performance of PET/CT in detecting PC is optimal when integrating 18F-FDG and 68Ga-DOTA-peptide PET/CT findings. In the subgroup analysis, the SUV max ratio seems to be the most accurate index in predicting TC. Both methods should be performed when PC is suspected or when the histological subtype is undefined.
本研究旨在回顾性评估和比较 68Ga-DOTA-肽和 18F-FDG PET/CT 在肺类癌（PC）术前评估中的检出率（DR），并评估两种示踪剂获得的各种功能指标在预测 PC 的组织学特征（即典型与非典型）方面的效用。
本研究纳入了 2009 年 1 月至 2013 年 4 月期间在 2 个中心接受 18F-FDG 和 68Ga-DOTA-肽 PET/CT 的 33 例确诊为 PC 的连续患者。半定量评估包括 SUVmax、肿瘤相对于 18F-FDG（SUV T/L）或 68Ga-DOTA-肽（SUV T/S）最大肝摄取的 SUV、68Ga-DOTA-肽 PET/CT 和 18F-FDG PET/CT 的 SUVmax 比值（SUVmax 比值）。组织学作为参考标准。
明确诊断为 23 例典型类癌（TCs）和 10 例非典型类癌。18F-FDG PET/CT 阳性 18 例，阴性 15 例（55% DR）。68Ga-DOTA-肽 PET/CT 阳性 26 例，阴性 7 例（79% DR）。在亚组分析中，68Ga-DOTA-肽 PET/CT 在检测 TC 方面更具优势（91% DR；P<0.001），而 18F-FDG PET/CT 在检测非典型类癌方面更具优势（100% DR；P=0.04）。SUVmax 比值是识别 TC 的最准确的半定量指标。
当整合 18F-FDG 和 68Ga-DOTA-肽 PET/CT 结果时，PET/CT 在检测 PC 中的总体诊断性能最佳。在亚组分析中，SUVmax 比值似乎是预测 TC 的最准确指标。当怀疑 PC 存在或组织学亚型不明确时，应同时进行两种方法。
