Szyszko Teresa A, Yip Connie, Szlosarek Peter, Goh Vicky, Cook Gary J R
King's College London and Guy's & St. Thomas' PET Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, London SE1 7EH, UK; Department of Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
King's College London and Guy's & St. Thomas' PET Centre, Division of Imaging Sciences and Biomedical Engineering, King's College London, London SE1 7EH, UK; Department of Cancer Imaging, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK; Department of Radiation Oncology, National Cancer Centre Singapore 169610, Singapore.
Lung Cancer. 2016 Apr;94:7-14. doi: 10.1016/j.lungcan.2016.01.010. Epub 2016 Jan 21.
18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET/CT) is established for characterising indeterminate pulmonary nodules and staging lung cancer where there is curative intent. Whilst a sensitive technique, specificity for characterising lung cancer is limited. There is recognition that evaluation of other aspects of abnormal cancer biology in addition to glucose metabolism may be more helpful in characterising tumours and predicting response to novel targeted cancer therapeutics. Therefore, efforts have been made to develop and evaluate new radiopharmaceuticals in order to improve the sensitivity and specificity of PET imaging in lung cancer with regards to characterisation, treatment stratification and therapeutic monitoring. 18F-fluorothymidine (18F-FLT) is a marker of cellular proliferation. It shows a lower accumulation in tumours than 18F-FDG as it only accumulates in the cells that are in the S phase of growth and demonstrates a low sensitivity for nodal staging. Its main role is in evaluating treatment response. Methionine is an essential amino acid. 11C-methionine is more specific and sensitive than 18F-FDG in differentiating benign and malignant thoracic nodules. 18Ffluoromisonidazole (18F-FMISO) is used for imaging tumour hypoxia. Tumour response to treatment is significantly related to the level of tumour oxygenation. Angiogenesis is the process by which new blood vessels are formed in tumours and is involved in tumour growth and metastatic tumour spread and is a therapeutic target. Most clinical studies have focused on targeted integrin PET imaging of which αvβ3 integrin is the most extensively investigated. It is upregulated on activated endothelial cells in association with tumour angiogenesis. Neuroendocrine tumour tracers, particularly 68Ga-DOTA-peptides, have an established role in imaging of carcinoid tumours. Whilst most of these tracers have predominantly been used in the research environment, they offer exciting opportunities for improving staging, characterisation, stratification and response assessment in an era of increased personalised therapy in lung cancer.
18F-氟脱氧葡萄糖（18F-FDG）正电子发射断层扫描-计算机断层扫描（PET/CT）已被用于对不确定的肺结节进行特征描述以及对有治愈意图的肺癌进行分期。虽然这是一种敏感技术，但用于肺癌特征描述的特异性有限。人们认识到，除了葡萄糖代谢外，评估癌症生物学异常的其他方面可能对肿瘤特征描述和预测新型靶向癌症治疗的反应更有帮助。因此，已努力开发和评估新的放射性药物，以提高PET成像在肺癌特征描述、治疗分层和治疗监测方面的敏感性和特异性。18F-氟胸苷（18F-FLT）是细胞增殖的标志物。它在肿瘤中的积聚低于18F-FDG，因为它只积聚在处于生长S期的细胞中，并且对淋巴结分期的敏感性较低。其主要作用是评估治疗反应。蛋氨酸是一种必需氨基酸。11C-蛋氨酸在区分良性和恶性胸部结节方面比18F-FDG更具特异性和敏感性。18F-氟米索硝唑（18F-FMISO）用于成像肿瘤缺氧情况。肿瘤对治疗的反应与肿瘤氧合水平显著相关。血管生成是肿瘤中形成新血管的过程，参与肿瘤生长和转移扩散，是一个治疗靶点。大多数临床研究都集中在靶向整合素PET成像上，其中αvβ3整合素是研究最广泛的。它在与肿瘤血管生成相关的活化内皮细胞上上调。神经内分泌肿瘤示踪剂，特别是68Ga-DOTA-肽，在类癌肿瘤成像中具有既定作用。虽然这些示踪剂大多主要用于研究环境，但在肺癌个性化治疗日益增加的时代，它们为改善分期、特征描述、分层和反应评估提供了令人兴奋的机会。
