锝-99m 地普奥肽闪烁扫描术在疑似肺癌患者诊断及管理中的作用。

Role of scintigraphy with technetium-99m depreotide in the diagnosis and management of patients with suspected lung cancer.

作者信息

Axelsson R, Herlin G, Bååth M, Aspelin P, Kölbeck K G

机构信息

Division of Radiology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institute, Stockholm, Sweden.

出版信息

Acta Radiol. 2008 Apr;49(3):295-302. doi: 10.1080/02841850701793777.

DOI:10.1080/02841850701793777

PMID:18365818

Abstract

BACKGROUND

In Sweden, there are over 3000 new lung cancer cases every year. There are still numerous patients with undetermined lesions after routine diagnostic evaluation by clinical examination, chest radiography, computed tomography (CT) of the thorax, and bronchoscopy. An appropriate method for further diagnostic workup is therefore needed.

PURPOSE

To evaluate the diagnostic value of the somatostatin analogue depreotide in patients with suspected lung cancer, and to determine in which clinical settings it would be beneficial to use 99mTc-depreotide scintigraphy.

MATERIAL AND METHODS

We included 99 consecutive patients referred to our hospital with suspected lung cancer. A clinical examination, bronchoscopy, chest radiography, CT of the thorax and upper abdomen, and scintigraphy were done. Scintigraphy was performed after injection of 740 MBq (99m)Tc depreotide with tomographical imaging of the thorax and whole-body scanning. The diagnostic outcome of the scintigrams was compared to CT, using morphology or clinical outcome as the endpoint.

RESULTS

99mTc-depreotide uptake was found in 62 out of 66 malignancies, including 57 of 58 primary lung cancer cases. Two cases of lung metastasis (one from a colon cancer and one from an adenoid cystic carcinoma originating in the palate) and one rib chondrosarcoma did not show depreotide uptake. There were 33 patients with benign lesions, of whom 16 displayed false-positive 99mTc-depreotide uptake, whereof 11 were pneumonias. Tc-99m-depreotide uptake was absent in 17 patients with benign lesions, including all 10 hamartomas. The sensitivity in detecting malignancy was 94%, and in detecting lung cancer 98%. The specificity was calculated based on two sets of data. When all cases were used, the specificity was 52%. If the 12 pneumonias are excluded, the specificity was 77%.

CONCLUSION

99mTc-depreotide scintigraphy has a high sensitivity in detecting lung cancer. The method is useful in decision-making with respect to surgery.

摘要

背景

在瑞典，每年有超过3000例新发肺癌病例。经过临床检查、胸部X线摄影、胸部计算机断层扫描（CT）和支气管镜检查等常规诊断评估后，仍有许多患者的病变无法确定。因此，需要一种合适的进一步诊断检查方法。

目的

评估生长抑素类似物depreotide对疑似肺癌患者的诊断价值，并确定在哪些临床情况下使用99mTc-depreotide闪烁扫描术有益。

材料与方法

我们纳入了99例因疑似肺癌转诊至我院的连续患者。进行了临床检查、支气管镜检查、胸部X线摄影、胸部和上腹部CT以及闪烁扫描。在注射740MBq（99m）Tc depreotide后进行闪烁扫描，并对胸部进行断层成像和全身扫描。以形态学或临床结果为终点，将闪烁扫描图的诊断结果与CT进行比较。

结果

66例恶性肿瘤中有62例发现99mTc-depreotide摄取，其中58例原发性肺癌中有57例。2例肺转移瘤（1例来自结肠癌，1例来自腭部腺样囊性癌）和1例肋骨软骨肉瘤未显示depreotide摄取。有33例良性病变患者，其中16例显示99mTc-depreotide摄取假阳性，其中11例为肺炎。17例良性病变患者未出现Tc-99m-depreotide摄取，包括所有10例错构瘤。检测恶性肿瘤的敏感性为94%，检测肺癌的敏感性为98%。特异性基于两组数据计算。当使用所有病例时，特异性为52%。如果排除12例肺炎，特异性为77%。