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整合素受体显像99mTc-3PRGD2 SPECT/CT用于非小细胞肺癌诊断及淋巴结分期的价值

靳晓娜 梁乃新 王孟昭 贾兵 石希敏 李单青 李方 王凡 朱朝晖

靳晓娜, 梁乃新, 王孟昭, 贾兵, 石希敏, 李单青, 李方, 王凡, 朱朝晖. 整合素受体显像99mTc-3PRGD2 SPECT/CT用于非小细胞肺癌诊断及淋巴结分期的价值[J]. 协和医学杂志, 2016, 7(5): 327-333. doi: 10.3969/j.issn.1674-9081.2016.05.002
引用本文: 靳晓娜, 梁乃新, 王孟昭, 贾兵, 石希敏, 李单青, 李方, 王凡, 朱朝晖. 整合素受体显像99mTc-3PRGD2 SPECT/CT用于非小细胞肺癌诊断及淋巴结分期的价值[J]. 协和医学杂志, 2016, 7(5): 327-333. doi: 10.3969/j.issn.1674-9081.2016.05.002
Xiao-na JIN, Nai-xin LIANG, Meng-zhao WANG, Bing JIA, Xi-min SHI, Shan-qing LI, Fang LI, Fan WANG, Zhao-hui ZHU. Integrin Receptor Imaging 99mTc-3PRGD2 SPECT/CT in Diagnosis and Lymph Node Staging of Non-Small Cell Lung Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2016, 7(5): 327-333. doi: 10.3969/j.issn.1674-9081.2016.05.002
Citation: Xiao-na JIN, Nai-xin LIANG, Meng-zhao WANG, Bing JIA, Xi-min SHI, Shan-qing LI, Fang LI, Fan WANG, Zhao-hui ZHU. Integrin Receptor Imaging 99mTc-3PRGD2 SPECT/CT in Diagnosis and Lymph Node Staging of Non-Small Cell Lung Cancer[J]. Medical Journal of Peking Union Medical College Hospital, 2016, 7(5): 327-333. doi: 10.3969/j.issn.1674-9081.2016.05.002

整合素受体显像99mTc-3PRGD2 SPECT/CT用于非小细胞肺癌诊断及淋巴结分期的价值

doi: 10.3969/j.issn.1674-9081.2016.05.002
基金项目: 

国家自然科学基金 81171369

北京市科委"首都特色"临床专项 Z151100004015157

教育部博士点优秀青年教师科研基金 20131106120063

详细信息
    通讯作者:

    王凡 电话:010-82802871, E-mail:wangfan@bjmu.edu.cn

    朱朝晖 电话:010-69154196, E-mail:zhuzhh@pumch.cn

  • 中图分类号: R445.6

Integrin Receptor Imaging 99mTc-3PRGD2 SPECT/CT in Diagnosis and Lymph Node Staging of Non-Small Cell Lung Cancer

More Information
  • 摘要:   目的  通过与18F-FDG PET/CT比较, 前瞻性评估整合素αvβ3受体显像99mTc-3PRGD2 SPECT/CT对非小细胞肺癌诊断及淋巴结分期的价值。  方法  前瞻性纳入2011年2月至2012年12月北京协和医院知情同意参与研究的65例肺占位病变患者。其中男41例, 女24例, 平均年龄(60±11)岁。患者在1周内分别行99mTc-3PRGD2 SPECT/CT和18F-FDG PET/CT检查。完成病理诊断后, 随访至死亡或随访至少2年。用受试者工作特征曲线、Z检验、卡方检验比较两种方法对肺内病灶及纵隔淋巴结的诊断效能。  结果  53例患者共65个病灶经病理证实为非小细胞肺癌, 12例患者共14个病灶诊断为良性病变。基于美国癌症联合委员会/国际抗癌联盟纵隔分区, 248个区域有肿瘤转移淋巴结, 56个区域有良性淋巴结。在诊断纵隔淋巴结转移方面, 99mTc-3PRGD2 SPECT/CT特异性显著高于18F-FDG PET/CT(94.6%比75.0%, P=0.008), 而两者的敏感性差异无统计学意义(88.3%比90.7%, P=0.557)。两种方法对肺内病变的诊断效能差异无统计学意义(Z=0.82, P=0.410)。  结论  整合素受体显像99mTc-3PRGD2 SPECT/CT在诊断淋巴结转移方面具有较高的特异性, 可能弥补18F-FDG PET/CT的不足, 在肺癌手术决策方面具有更大价值。
  • 图  1  99mTc-3PRGD2 SPECT/CT与18F-FDG PET/CT图像的比较

    40岁女性,右上肺低分化腺癌患者,99mTc-3PRGD2分布呈肿瘤中心高、边缘低(A),18F-FDG分布呈肿瘤中心低、边缘高(B);a、b、c分别为冠状面、矢状面、横断面图像

    图  2  肺癌与炎症99mTc-3PRGD2 SPECT/CT与18F-FDG PET/CT显像的比较

    A.45岁女性,右下肺腺癌患者,MIP图像示病灶对18F-FDG和99mTc-3PRGD2高摄取(蓝色箭头)和淋巴结转移(红色箭头)(a, b),CT肺窗示右下肺病灶(c); B. 40岁女性,MIP图像示右下肺慢性炎症(蓝色箭头)和淋巴结(红色箭头)对18F-FDG摄取明显高(a),对99mTc-3PRGD2摄取却很低(b),CT肺窗示右下肺病变(c)MIP:最大强度投影

    表  1  99mTc-3PRGD2 SPECT/CT和18F-FDG PET/CT在肺癌诊断和转移淋巴结评估中的受试者工作特征曲线分析结果

    项目 检查方法 曲线下面积 标准误 95%置信区间 Z P
    肺癌诊断(n=79) 99mTc-3PRGD2 SPECT/CT 0.674 0.107 0.467~0.881 0.82 0.410
    18F-FDG PET/CT 0.768 0.076 0.620~0.917
    转移淋巴结评估(n=304) 99mTc-3PRGD2 SPECT/CT 0.970 0.009 0.952~0.988 8.00 <0.001
    18F-FDG PET/CT 0.792 0.035 0.724~0.859
    下载: 导出CSV

    表  2  99mTc-3PRGD2 SPECT/CT和18F-FDG PET/CT在肺癌诊断和转移淋巴结评估中诊断参数的比较

    项目 检查方法 阳性标准 敏感性 特异性 准确性 阳性预测值 阴性预测值
    肺癌诊断 99mTc-3PRGD2 SPECT/CT T/B>4.4 64.6%(42/65) 64.3%(9/14) 64.6%(51/79) 89.4%(42/47) 28.1%(9/32)
    (n=79) 18F-FDG PET/CT T/B>8.0 76.9%(50/65) 64.3%(9/14) 74.7%(59/79) 90.9%(50/55) 37.5%(9/24)
    P 0.039 0.625 0.210 0.793 0.457
    淋巴结评估 99mTc-3PRGD2 SPECT/CT T/B>1.2 88.3%(219/248) 94.6%(53/56) 89.4%(272/304) 98.6%(219/222) 64.6%(53/82)
    (n=304) 18F-FDG PET/CT T/B>1.6 90.7 %(225/248) 75.0%(42/56) 87.8%(267/304) 94.1%(225/239) 64.6%(42/65)
    P 0.557 0.008 0.362 0.010 0.998
    下载: 导出CSV
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  • 收稿日期:  2016-07-31
  • 刊出日期:  2016-09-30

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