STAGING NON-SMALL CELL LUNG CANCER WITH PET

新诊断的原发性非小细胞肺癌手术治愈的可能性 细胞性肺癌在很大程度上依赖于局部的 癌症，尤其是纵隔淋巴结是否 与癌症有关。五年存活率约为8% 在纵隔淋巴结受累于癌症的患者中， 无纵隔转移时为46%。潜在的治愈方法 开胸合并肺叶切除或全肺切除的手术方法 大量死亡率(+5%)和发病率(+10%)，是不适当的 患者的疾病负担如此广泛以至于不能切除。 而且无法治愈。而标准的横断面成像方法，如 最近的研究表明，CT或MRI是手术前常规的分期方法 已经证明，这些方法是：1)不能检测到微小的 纵隔淋巴结转移癌的非转移灶 放大，20个不能具体确定边界 或中度增大的纵隔淋巴结与癌症有关。 因此，这些横断面方法的敏感性和特异性 并不是最优的。我们建议前瞻性地评估 FDG和~(11)C-L-甲硫氨酸联合应用于乳腺癌的术前PET扫描 新发肿瘤患者纵隔肿瘤转移的检测 诊断为非小细胞肺癌。对患者进行CT和PET扫描 这类患者在手术前将首先单独进行解释，然后 CT和正电子发射计算机断层扫描将一起解释。此外，CT 和PET图像将使用计算机图像融合方法进行联合配准 并产生了一系列的解剖/代谢融合图像。这些 代谢/解剖融合图像也将被解释为增强 PET分期的解剖定位及诊断准确性 程序。患者还将接受静脉注射。FDG示踪剂注射 手术前即刻，以便可以测量FDG的摄取 在含有肿瘤受累组织和正常组织的活检标本中。 胸外科，特别是对定义明确的美国胸科进行抽样 学会指定的纵隔结节区域，将被执行。节点 切除的癌症和淋巴结的组织学和FDG摄取将是 确定的，与癌症的存在或不存在相关的。这个 CT和PET单独解释的准确性，然后两者一起解释 无论有没有代谢/解剖融合图像，都将 而不是病态的“真相”。这些结果将被用来 制定和优化PET在肿瘤分期中的解释标准 非小细胞肺癌患者的纵隔病变。这些 标准将前瞻性地应用于第三组中成像的患者 以及该提案的第四个年头。通过这项研究，我们希望 确定FDG的准确性，从而确定其潜在的诊断效用 ~(11)C-L-甲硫氨酸正电子发射计算机体层摄影术前分期 非小细胞肺癌患者。

The likelihood for a surgical cure of newly-diagnosed primary non-small cell lung cancers is strongly dependent upon the local extent of the cancer, particularly whether or not the mediastinal lymph nodes are involved with cancer. Five year survivals of approximately 8% ar seen in patients whose mediastinal lymph nodes are involved with cancer vs. 46% when there are no mediastinal metastases. The potentially curative surgical procedures of thoracotomy with lobectomy or pneumonectomy cause substantial mortality (+5%) and morbidity (+10%) and are inappropriate of the patients disease burden is so extensive as to be non-resectable and non-curable. While standard cross-sectional imaging methods such as CT or MRI are routinely used pre-operatively for staging, recent studies have demonstrated that these methods are: 1) incapable of detecting small foci of metastatic cancer in mediastinal lymph nodes that are not enlarged, and 20 incapable of specifically determining whether borderline or moderately-enlarged mediastinal lymph nodes are involved with cancer. Thus, the sensitivity and specificity of these cross-sectional methods are not optimal. We propose to prospectively evaluate the accuracy of pre-operative PET scanning using FDG and 11C-L- methionine for the detection of mediastinal tumor metastases in patients with newly- diagnosed non-small cell lung cancers. CT and PET scans performed on such patients prior to surgery will first be interpreted separately, then the CT and PET scans will be interpreted together. In addition, the CT and PET images will be co-registered using computer image fusion methods and a series of anatomic/metabolic fusion images produced. These metabolic/anatomic fusion images will also be interpreted to enhance the anatomic localization and diagnostic accuracy of the PET staging procedure. Patients will also receive an i.v. tracer injection of FDG immediately prior to surgery, so that the uptake of FDG can be measured in biopsy specimens containing tumor-involved and normal tissues. Thoracic surgery, specifically sampling well-defined American Thoracic Society designated mediastinal nodal regions, will be performed. Nodal histology and FDG uptake in the resected cancers and lymph nodes will be determined and correlated with the presence or absence of cancer. The accuracy of CT and PET interpreted independently, and then together both with, and without, the metabolic/anatomic fusion images, will then be compared to pathological 'truth'. These results will then be used to develop and optimize interpretative criteria for PET in the staging of the mediastinum in patients with non-small cell lung cancer. These criteria will be applied prospectively to patients imaged in the third and fourth year of the proposal. Through this study we expect to determine the accuracy, and thus the potential diagnostic utility, of FDG and 11C-L-methionine PET scanning in the pre-operative staging of patients with non-small cell lung cancers.