Department of Thoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
Thorac Cancer. 2024 Sep;15(27):1958-1967. doi: 10.1111/1759-7714.15421. Epub 2024 Aug 14.
Lymph node (LN) metastasis is a significant prognostic factor for esophageal squamous cell carcinoma (ESCC), and there are no satisfactory methods for accurately predicting metastatic LNs. The present study aimed to assess the efficacy of Tc-3PRGD single-photon emission computed tomography (SPECT)/computed tomography (CT) for diagnosing metastatic LNs in ESCC.
A total of 15 enrolled patients with ESCC underwent Tc-3PRGD SPECT/CT and 18F-fluorodeoxyglucose positron emission tomography-computed tomography (F-FDG PET/CT) examinations preoperatively. High-definition bone carving reconstruction technology (HD-xSPECT Bone) was applied to quantitatively assess the LN's SUV via SPECT/CT. The two methods were compared for diagnosing metastatic LNs with pathology as the gold standard.
Among 15 patients, 23 metastatic lymph node stations (mLNSs) were predicted by SPECT/CT, with a mean SUV of 2.71 ± 1.34, of which 15 were pathologically confirmed; 32 mLNSs were predicted by PET/CT with a mean SUV of 4.41 ± 4.02, of which 17 were pathologically confirmed. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of SPECT/CT for diagnosing metastatic LNs were 62.50%, 91.30%, 85.34%, 65.22%, and 90.32%, respectively, and those of PET/CT were 70.83%, 83.70%, 81.03%, 53.13%, and 91.67%, respectively. There was no significant difference in sensitivity (p = 0.061) or specificity (p = 0.058) between the two methods. The AUC was 0.816 and the SUV threshold was 2.5.
Tc-3PRGD SPECT/CT might be an effective method for diagnosing metastatic LNs in ESCC, especially in combination with HD-xSPECT Bone. The diagnostic efficiency of this method was noninferior to that of F-FDG PET/CT. The SUV threshold of 2.5 showed the highest agreement with the pathology findings.
淋巴结（LN）转移是食管鳞状细胞癌（ESCC）的重要预后因素，目前尚无准确预测转移性 LN 的满意方法。本研究旨在评估 Tc-3PRGD 单光子发射计算机断层扫描（SPECT）/计算机断层扫描（CT）诊断 ESCC 患者转移性 LN 的效能。
共纳入 15 例 ESCC 患者，分别行 Tc-3PRGD SPECT/CT 和 18F-氟脱氧葡萄糖正电子发射断层扫描-CT（F-FDG PET/CT）检查。采用高清骨雕刻重建技术（HD-xSPECT Bone）对 SPECT/CT 定量评估 LN 的 SUV。以病理为金标准，比较两种方法诊断转移性 LN 的效能。
15 例患者共预测出 23 个转移性淋巴结站（mLNS），SPECT/CT 预测的平均 SUV 为 2.71±1.34，其中 15 个经病理证实；PET/CT 预测出 32 个 mLNS，平均 SUV 为 4.41±4.02，其中 17 个经病理证实。SPECT/CT 诊断转移性 LN 的敏感度、特异度、准确度、阳性预测值和阴性预测值分别为 62.50%、91.30%、85.34%、65.22%和 90.32%，PET/CT 分别为 70.83%、83.70%、81.03%、53.13%和 91.67%。两种方法的敏感度（p=0.061）或特异度（p=0.058）差异均无统计学意义。AUC 为 0.816，SUV 阈值为 2.5。
Tc-3PRGD SPECT/CT 可能是诊断 ESCC 转移性 LN 的有效方法，尤其是与 HD-xSPECT Bone 相结合时。该方法的诊断效能不劣于 F-FDG PET/CT。SUV 阈值为 2.5 时与病理结果一致性最高。
