Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine. Stanford, California.
Department of Research, Intuitive Surgical Inc., Sunnyvale, California.
Clin Cancer Res. 2022 Oct 14;28(20):4425-4434. doi: 10.1158/1078-0432.CCR-22-0094.
Determine the safety and specificity of a tumor-targeted radiotracer (89Zr-pan) in combination with 18F-FDG PET/CT to improve diagnostic accuracy in head and neck squamous cell carcinoma (HNSCC).
Adult patients with biopsy-proven HNSCC scheduled for standard-of-care surgery were enrolled in a clinical trial and underwent systemic administration of 89Zirconium-panitumumab and panitumumab-IRDye800 followed by preoperative 89Zr-pan PET/CT and intraoperative fluorescence imaging. The sensitivity, specificity, and AUC were evaluated.
A total of fourteen patients were enrolled and completed the study. Four patients (28.5%) had areas of high 18F-FDG uptake outside the head and neck region with maximum standardized uptake values (SUVmax) greater than 2.0 that were not detected on 89Zr-pan PET/CT. These four patients with incidental findings underwent further workup and had no evidence of cancer on biopsy or clinical follow-up. Forty-eight lesions (primary tumor, LNs, incidental findings) with SUVmax ranging 2.0-23.6 were visualized on 18F-FDG PET/CT; 34 lesions on 89Zr-pan PET/CT with SUVmax ranging 0.9-10.5. The combined ability of 18F-FDG PET/CT and 89Zr-pan PET/CT to detect HNSCC in the whole body was improved with higher specificity of 96.3% [confidence interval (CI), 89.2%-100%] compared to 18F-FDG PET/CT alone with specificity of 74.1% (CI, 74.1%-90.6%). One possibly related grade 1 adverse event of prolonged QTc (460 ms) was reported but resolved in follow-up.
89Zr-pan PET/CT imaging is safe and may be valuable in discriminating incidental findings identified on 18F-FDG PET/CT from true positive lesions and in localizing metastatic LNs.
确定肿瘤靶向放射性示踪剂（89Zr- pan）与 18F-FDG PET/CT 联合应用的安全性和特异性，以提高头颈部鳞状细胞癌（HNSCC）的诊断准确性。
入组了经活检证实的 HNSCC 成年患者，他们计划接受标准治疗手术，并接受系统的 89Zr- panitumumab 和 panitumumab-IRDye800 给药，随后进行术前 89Zr-pan PET/CT 和术中荧光成像。评估了灵敏度、特异性和 AUC。
共入组了 14 例患者并完成了研究。4 例患者（28.5%）的头颈部区域外有高 18F-FDG 摄取区域，最大标准化摄取值（SUVmax）大于 2.0，但 89Zr-pan PET/CT 未检测到。这 4 例偶然发现的患者接受了进一步的检查，活检和临床随访均无癌症证据。48 个病灶（原发肿瘤、淋巴结、偶然发现）的 SUVmax 值范围为 2.0-23.6，在 18F-FDG PET/CT 上可见；34 个病灶在 89Zr-pan PET/CT 上，SUVmax 值范围为 0.9-10.5。与单独使用 18F-FDG PET/CT 相比，18F-FDG PET/CT 和 89Zr-pan PET/CT 联合检测全身 HNSCC 的能力提高，特异性为 96.3%（90.6%-100%），而单独使用 18F-FDG PET/CT 的特异性为 74.1%（74.1%-90.6%）。报告了 1 例可能与 QTc 延长相关的 1 级不良事件（460 ms），但在随访中得到解决。
89Zr-pan PET/CT 成像安全，可能有助于鉴别 18F-FDG PET/CT 上发现的偶然发现与真正的阳性病变，并定位转移性淋巴结。
