锝-3PRGD单光子发射计算机断层扫描（Tc-3PRGD SPECT）在食管癌患者术前淋巴结转移评估中相对于计算机断层扫描（CT）的优势。

Advantages of Tc-3PRGD SPECT over CT in the preoperative assessment of lymph node metastasis in patients with esophageal cancer.

作者信息

Lv Ningning, Gao Shi, Bai Lin, Ji Bin, Xue Jinru, Ge Xiaoguang, Chen Bin

机构信息

Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China.

Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.

出版信息

Ann Nucl Med. 2019 Jan;33(1):39-46. doi: 10.1007/s12149-018-1300-x. Epub 2018 Sep 14.

DOI:10.1007/s12149-018-1300-x

PMID:30218281

Abstract

BACKGROUND

Our study was designed to compare the diagnostic efficacies of integrated Tc-HYNIC-PEG4-E[PEG4-c(RGDfK)]2 (Tc-3PRGD) single-photon emission computed tomography (SPECT) images and computed tomography (CT) images in lymph node metastasis in the patients with esophageal cancer.

METHODS

From September 2015 and May 2018, 32 patients with histologically proven primary esophageal carcinoma underwent both Tc-3PRGD SPECT and CT scans followed by esophagectomy with lymph node dissection. The results of reviewing Tc-3PRGD SPECT and CT images for the lymph node metastasis were compared in relation with pathologic findings.

RESULTS

During surgery, a total of 168 lymph nodes were dissected in 32 patients, of which 42 node groups in 18 patients were malignant on histologic examination. Preoperative nodal staging was compared with postoperative histopathological staging, The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of Tc-3PRGD SPECT for lymph nodes were 80.95%, 86.51%, 85.12%, 66.67%, and 93.16% on per-node basis, respectively; compared with 59.52%, 73.02%, 69.64%, 42.37%, and 84.40% for CT (p = 0.034, 0.008, 0.005, 0.011, and 0.038, respectively). 70.59% (12/17) false-negative interpretations and 50% (17/34) false-positive interpretations on CT were corrected by Tc-3PRGD SPECT. 37.5% false-negative interpretations on Tc-3PRGD SPECT were corrected by CT. 11.90% (5/42) positive lymph nodes and 13.49% (17/126) negative nodes at pathology were incorrectly diagnosed both by Tc-3PRGD SPECT and CT. The accuracy of Tc-3PRGD SPECT (87.50%, 28/32) was significantly higher than that of CT (62.50, 20/32; p = 0.022) on per-patient basis. Tc-3PRGD SPECT showed significantly higher sensitivity and accuracy in the neck and upper thoracic regions than CT. For nodal staging, Tc-3PRGD SPECT was correct in 78.12% (25/32) of the patients, whereas CT was correct in 53.12% (17/32), p = 0.037.

CONCLUSION

Tc-3PRGD SPECT is more accurate than CT for preoperative assessment of lymph node metastasis in esophageal cancer and may be helpful in determining the therapeutic plan.

摘要

背景

本研究旨在比较整合的锝[Tc]-HYNIC-PEG4-E[PEG4-c(RGDfK)]2（Tc-3PRGD）单光子发射计算机断层扫描（SPECT）图像与计算机断层扫描（CT）图像对食管癌患者淋巴结转移的诊断效能。

方法

2015年9月至2018年5月，32例经组织学证实为原发性食管癌的患者接受了Tc-3PRGD SPECT和CT扫描，随后进行了食管癌切除术及淋巴结清扫术。将Tc-3PRGD SPECT和CT图像上淋巴结转移的检查结果与病理结果进行比较。

结果

手术过程中，32例患者共清扫168枚淋巴结，其中18例患者的42组淋巴结经组织学检查为恶性。将术前淋巴结分期与术后组织病理学分期进行比较，Tc-3PRGD SPECT对淋巴结的敏感性、特异性、准确性、阳性预测值和阴性预测值分别为80.95%、86.51%、85.12%、66.67%和93.16%；CT的相应值分别为 59.52%、73.02%、69.64%、42.37%和84.40%（p分别为0.034、0.008、0.005、0.011和0.038）。Tc-3PRGD SPECT纠正了CT上70.59%（12/17）的假阴性判读和50%（17/34）的假阳性判读。CT纠正了Tc-3PRGD SPECT上37.5%的假阴性判读。病理检查中，11.90%（5/42）的阳性淋巴结和13.49%（17/126）的阴性淋巴结被Tc-3PRGD SPECT和CT均误诊。基于患者层面，Tc-3PRGD SPECT的准确性（87.50%，28/32）显著高于CT（62.50%，20/32；p = 0.022）。Tc-3PRGD SPECT在颈部和上胸部区域的敏感性和准确性显著高于CT。对于淋巴结分期，Tc-3PRGD SPECT在78.12%（25/32）的患者中判断正确，而CT在53.12%（17/32）的患者中判断正确，p = 0.037。