Evaluation of thoracic tumors with 18F-fluorothymidine and 18F-fluorodeoxyglucose-positron emission tomography
Evaluation of thoracic tumors with 18F-fluorothymidine and 18F-fluorodeoxyglucose-positron emission tomography
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DOI：
10.1378/chest.129.2.393
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发表时间：
2006-02-01
期刊：
影响因子：
9.6
通讯作者：
Weber, WA
中科院分区：
文献类型：
--
作者：
Yap, CS;Czernin, J;Weber, WA
研究目的：18F-氟脱氧葡萄糖（FDG）是用于癌症的诊断、分期、再分期和监测治疗反应的最广泛使用的正电子发射断层扫描（PET）成像探针。然而，其特异性不太理想。一种新的分子成像探针（18 F-脱氧氟胸苷[FLT]）已经开发出来，可能提供更特异的肿瘤成像。本研究的目的如下：（1）比较FDG-PET和FLT-PET在肿瘤分期中的应用，（2）比较肺病变中FDG和FLT摄取的程度，（3）确定PET摄取强度与肿瘤细胞增殖之间的相关性。设计：对11例孤立性肺结节和11例非小细胞肺癌（NSCLC）患者进行FDG-PET和FLT-PET扫描。通过标准化摄取值（SUV）定量评估示踪剂摄取。从活检标本或手术切除获得的组织样本的组织学评价作为“金标准”。结果：22例患者的99个组织样本（29个肺病变、66个淋巴结转移和4个肺外病变）均获得了病理学证实。33例（33.3%）肿瘤组织阳性（22例肺、9例淋巴结和2例肺外）。FDG-PET结果在三个肺部病变中为假阳性，而FLT-PET结果在一个病变中为假阳性。FDG-PET有2例假阴性结果，FLT-PET有6例假阴性结果。恶性病变的FDG摄取明显高于FLT（最大SUV，3.1 +/- 2.6 vs 1.6 +/- 1.2 [mean +/- SD]; p < 0.05）。肺病灶的FLT摄取与Ki-67标记指数显著相关（r = 0.60，p = 0.02），但与FDG摄取无显著相关性（r = 0.27，p = not significant）。结论：与FDG-PET相比，FLT-PET检测原发性和转移性NSCLC受限于肿瘤组织相对较低的FLT摄取。因此，FLT-PET不太可能提供比FDG-PET更准确的分期信息或更好的肺结节特征。然而，FLT摄取和细胞增殖之间的相关性表明，未来的研究应评估使用FLT-PET监测治疗与细胞抑制抗癌药物。
Study objectives: 18F-fluorodeoxyglucose (FDG) is the most widely used positron emission tomography (PET) imaging probe used for the diagnosis, staging, restaging, and monitoring therapy response of cancer. However, its specificity is less than ideal. A new molecular imaging probe (18F-deoxyfluorothymidine [FLT]) has been developed that might afford more specific tumor imaging. The aims of this study were as follows: (1) to compare the use of FDG-PET and FLT-PET for tumor staging, (2) to compare the degree of FDG and FLT uptake in lung lesions, and (3) to determine the correlation between PET uptake intensity and tumor cell proliferation.Design: FDG-PET and FLT-PET scans were performed in 11 patients with solitary pulmonary nodules and another 11 patients with known non-small cell lung cancer (NSCLC). Tracer uptake was assessed quantitatively by standardized uptake values (SUVs). Histologic evaluation of tissue samples obtained from biopsy specimens or surgical resections served as the "gold standard." Tumor cell proliferation was assessed by Ki-67 staining.Results: Pathology verification was available from 99 tissue samples in the 22 patients (29 pulmonary lesions, 66 lymph node stations, and 4 extrapulmonary lesions). Thirty-three samples (33.3%) were positive for tumor tissue (22 pulmonary, 9 lymph node stations, and 2 extrapulmonary). FDG-PET findings were false-positive in three pulmonary lesions, while FLT-PET findings were false-positive in one lesion. There were two false-negative findings by FDG-PET and six false-negative findings by FLT-PET. FDG uptake of the malignant lesions was significantly higher than FLT (maximum SUV, 3.1 +/- 2.6 vs 1.6 +/- 1.2 [mean +/- SD]; p < 0.05). A significant correlation was observed between FLT uptake of pulmonary lesions and Ki-67 labeling index (r = 0.60, p = 0.02) but not for FDG uptake (r = 0.27, p = not significant).Conclusions: Compared to FDG-PET, detection of primary and metastatic NSCLC by FLT-PET is limited by the relatively low FLT uptake of the tumor tissue. Thus, FLT-PET is unlikely to provide more accurate staging information or better characterization of pulmonary nodules than FDG-PET. Nevertheless, the correlation between FLT uptake and cellular proliferation suggests that future studies should evaluate the use of FLT-PET for monitoring treatment with cytostatic anticancer drugs.