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 细胞肺癌是强烈依赖于当地的程度， 癌症，特别是纵隔淋巴结是否 与癌症有关 5年生存率约为8% 在纵隔淋巴结涉及癌症的患者中， 46%，当没有纵隔转移。 可能的治愈 开胸肺叶或全肺切除术 显著的死亡率（+5%）和发病率（+10%）， 的患者疾病负担是如此广泛，以至于不可切除 并且不可治愈。 虽然标准的横截面成像方法， CT或MRI常规用于术前分期，最近的研究 已经证明这些方法是：1）不能检测小的 纵隔淋巴结中的转移癌病灶， 扩大，和20不能具体确定是否边界 或中度增大的纵隔淋巴结与癌症有关。 因此，这些横断面方法的灵敏度和特异性 并不是最佳的。 我们建议前瞻性地评估 使用FDG和11 C-L-蛋氨酸进行术前PET扫描， 纵隔肿瘤转移的检测在新的患者- 确诊的非小细胞肺癌。 进行CT和PET扫描， 这些患者在手术前将首先被单独解释，然后 CT和PET扫描将一起解读。 此外，CT 和PET图像将使用计算机图像融合方法进行配准 并产生一系列解剖/代谢融合图像。 这些 代谢/解剖融合图像也将被解释以增强 PET分期的解剖定位和诊断准确性 procedure. 患者还将接受FDG静脉示踪剂注射 在手术前立即进行，以便可以测量FDG的摄取 在包含肿瘤相关组织和正常组织的活检标本中。 胸外科手术，特别是采样定义明确的美国胸科 协会指定的纵隔淋巴结区域，将进行。 节点 切除的癌症和淋巴结中的组织学和FDG摄取将被 确定并与癌症的存在或不存在相关。 的 CT和PET的准确性独立解释，然后两者一起解释。 具有和不具有代谢/解剖融合图像，然后将 与病理学的“真相”相比。 这些结果将用于 制定和优化PET分期的解释标准 非小细胞肺癌患者的纵隔。 这些 标准将前瞻性地应用于第三次成像的患者， 第四年的提案。 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 和11 C-L-蛋氨酸PET扫描在术前分期中的作用 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.