Tc-99m-MAA lung shunt fraction before Y-90 radioembolization is low among patients with non-hepatocellular carcinoma malignancies
Tc-99m-MAA lung shunt fraction before Y-90 radioembolization is low among patients with non-hepatocellular carcinoma malignancies
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DOI：
10.1097/mnm.0000000000001089
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发表时间：
2019-11-01
影响因子：
1.5
通讯作者：
Bercu, Zachary L.
中科院分区：
文献类型：
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作者：
Elsayed, Mohammad;Martin, Jonathan G.;Bercu, Zachary L.
目的在钇-90放射性栓塞治疗前，无论潜在的肝脏恶性肿瘤类型如何，常规使用锝-99 m大分子聚集白蛋白进行肺分流分数研究。本研究评价了肝细胞癌与非肝细胞癌肝肿瘤中肺分流分数研究的作用。方法对2012年11月至2018年3月期间所有钇-90锝-99 m大聚集白蛋白肺分流分数研究进行了单机构回顾性分析。比较肝细胞癌和非肝细胞癌病例之间的患者变量，包括年龄、潜在恶性肿瘤、实验室值、肺分流分数和肝脏疾病的严重程度。结果在653例患者中，共发现734例锝-99 m大聚集白蛋白研究。其中肝细胞癌368例（50.1%），结直肠癌112例（15.3%），神经内分泌肿瘤89例（12.1%），胆管癌59例（8.0%），乳腺癌27例（3.7%），其他转移性恶性肿瘤79例（10.7%）。非肝细胞癌病例的平均肺分流分数为7.4%，显著低于肝细胞癌病例的平均肺分流分数11.7%（P = 0.0001）。只有1例非肝细胞癌病例由于肺分流分数高（69.3%）而未进行钇-90放射性栓塞，其中1例转移性胃肠道间质瘤患者的血管造影显示大规模分流明显。相比之下，37例肝细胞癌患者（平均肺分流率35.1%）的肺分流率太高，无法进行放射性栓塞。结论非肝癌性肝癌患者肺分流率较低。需要进一步分析检查在非肝细胞癌恶性肿瘤患者中进行Y 90前锝-99 m巨聚集白蛋白肺分流分数研究的必要性，因为在没有既往肺分流分数评价的情况下进行巩固的钇-90放射性栓塞可以减少资源消耗，改善工作流程和患者访问。
Objective Lung shunt fraction studies using technetium-99 m macro aggregated albumin are routinely performed before yttrium-90 radioembolization regardless of underlying liver malignancy type. This study evaluates the role of lung shunt fraction studies in hepatocellular carcinoma compared to non-hepatocellular carcinoma liver tumors. Methods A single-institution retrospective analysis of all pre-yttrium-90 technetium-99 m macro aggregated albumin lung shunt fraction studies between November 2012 to March 2018 was performed. Patient variables including age, underlying malignancy, laboratory values, lung shunt fraction, and severity of liver disease were compared between hepatocellular carcinoma and non-hepatocellular carcinoma cases. Results A total of 734 technetium-99 m macro aggregated albumin studies were identified in 653 patients. Among these cases, the liver tumor was hepatocellular carcinoma in 368 (50.1%), colorectal cancer in 112 (15.3%), neuroendocrine tumor in 89 (12.1%), cholangiocarcinoma in 59 (8.0%), breast cancer in 27 (3.7%), and other metastatic malignancies in 79 (10.7%). The mean lung shunt fraction for non-hepatocellular carcinoma cases was 7.4%, which was significantly lower than the mean lung shunt fraction, 11.7%, for hepatocellular carcinoma cases (P = 0.0001). In only one non-hepatocellular carcinoma case was yttrium-90 radioembolization not pursued due to high lung shunt fraction (69.3%), wherein large scale shunting was grossly apparent on angiography in a patient with metastatic gastrointestinal stromal tumor. In comparison, the lung shunt fraction was too high to pursue radioembolization in 37 hepatocellular carcinoma cases (mean lung shunt fraction 35.1%). Conclusion Lung shunt fraction appears low among patients with non-hepatocellular carcinoma liver malignancies. Further analysis examining the necessity of pre-Y90 technetium-99 m macro aggregated albumin lung shunt fraction studies in patients with non-hepatocellular carcinoma malignancies is warranted, since a consolidated yttrium-90 radioembolization without prior lung shunt fraction evaluation could reduce resource consumption, improve workflows, and patient access.