Role of 99mTc-Octreotide Acetate Scintigraphy in Suspected Lung Cancer Compared with 18F-FDG Dual-Head Coincidence Imaging

Feng Wang; Zizheng Wang; Weixuan Yao; Hong Xie; Jie Xu; Li Tian

doi:10.2967/jnumed.107.040824

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FIGURE 1.
A 46-y-old male patient with benign clear cell tumor. (A) CT scans showed abnormality in right upper lobe. (B) ¹⁸F-FDG coincidence images had intense uptake in lesion. (C) ^99mTc-Octreotide images were negative in lesion.
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FIGURE 2.
A 75-y-old male patient with adenosquamous lung cancer in left upper lobe. (A) CT scans showed abnormality in left upper lobe. (B) ¹⁸F-FDG coincidence images had intense uptake in lesion (arrows). (C) ^99mTc-Octreotide images showed intense uptake in primary tumor and pleura (arrows). (D) Adenosquamous lung cancer and pleural invasion were verified on histology.
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FIGURE 3.
A 57-y-old male patient with squamous lung cancer. (A) CT scans showed neoplasm high in upper lobe of right lung. (B) ¹⁸F-FDG coincidence images had focal uptake in lesion. (C) ^99mTc-Octreotide images had focal high uptake in lesion. (D) Squamous lung cancer and pleura and rib invasion were verified on histology.
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FIGURE 4.
A 65-y-old woman with lung adenocarcinoma. (A) CT scans revealed brain metastasis and peripheral edema in left temporal lobe. (B) ¹⁸F-FDG images showed low uptake in brain lesion. (C) ^99mTc-Octreotide images showed focal uptake in brain lesion.

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TABLE 1

Clinical Information and Histopathologic Database Used in Study

Patient no.	Sex	Age (y)	Histology	Primary lesion (cm)	Staging	T/N_r	T/N_m
1	F	52	Adenocarcinoma	2.0	T1 N3	2.54	5.56
2	M	51	Squamous cell carcinoma	4.2	T2 N3	2.24	6.62
3	M	57	Squamous cell carcinoma	3.0	T2 N0	4.1	9.86
4	M	75	Adenosquamous carcinoma	4.8	T4 N0	3.91	7.34
5	F	55	Adenocarcinoma	3.6	T2 N3 M1	3.29	5.46
6	M	59	Adenocarcinoma	4.2	T3 N3	2.82	6.35
7	M	76	Undifferentiated lung cancer	11.0	T4 N3	5.58	10.56
8	M	72	Adenocarcinoma	3.8	T2 N1	2.30	5.32
9	F	65	Adenocarcinoma	5.2	T4 N3 M1	3.78	8.23
10	F	61	Squamous cell carcinoma	3.2	T2 N0 M1	4.06	7.16
11	M	42	Squamous cell carcinoma	6.2	T4 N3 M1	4.61	5.35
12	M	70	Squamous cell carcinoma	7.8	T4 N3	3.36	10.23
13	F	60	Squamous cell carcinoma	5.3	T2 N3	2.98	9.18
14	M	71	Squamous cell carcinoma	3.5	T2 N2	3.63	6.45
15	M	75	Adenocarcinoma	4.8	T4 N3 M1	2.57	4.12
16	M	70	Squamous cell carcinoma	8.5	T4 N3	3.59	5.36
17	F	63	Adenocarcinoma	3.5	T2	3.87	4.96
18	M	64	Adenocarcinoma	4.5	T2 N3 M1	2.68	5.09
19	M	64	Small-cell lung carcinoma	6.5	T3 N2	3.42	4.49
20	F	64	Adenocarcinoma	3.8	T2 N3 M1	2.62	5.54
21	M	60	Adenocarcinoma	7.1	T3 N2	2.68	5.31
22	M	71	Adenocarcinoma	4.5	T2 N3 M1	4.13	6.23
23	F	44	Small-cell lung carcinoma	5.0	T3 N3 M1	3.32	5.16
24	M	70	Squamous cell carcinoma	8.5	T4 N3	3.36	7.16
25	M	73	Adenocarcinoma	5.1	T2 N0	2.89	4.86
26	M	54	Squamous cell carcinoma	7.5	T4 N3 M1	3.46	8.19
27	M	76	Adenocarcinoma	3.2	T4 N0	3.78	4.61
28	M	51	Small-cell lung carcinoma	7.1	T4 N3 M1	3.63	5.34
29	M	75	Small-cell lung carcinoma	2.8, 5.6	T4 N0 M1	3.98	4.55
30	F	56	Small-cell lung carcinoma	2.0, 5.0	T2 N0 M1	3.68	3.99
31	F	39	Small-cell lung carcinoma	3.2	T4 N0	4.09	5.32
32	F	51	Fibroma	1.2	—	1.29	1.42
33	F	66	Tuberculosis	3.3	—	1.13	2.10
34	F	70	Granuloma	2.3	—	1.56	3.92
35	F	62	Hamartoma	1.6	—	1.49	2.13
36	M	62	Tuberculosis	1.2	—	1.36	3.88
37	M	83	Pneumonia	2.5	—	1.78	1.89
38	M	75	Interstitial pneumonitis	1.0	—	1.39	1.78
39	M	46	Clear cell tumor	2.5	—	1.24	4.12
40	M	75	Tuberculosis	4.0	—	1.35	3.89
41	M	30	Tuberculosis	1.5	—	4.69	6.93
42	M	71	Granuloma	2.5	—	1.59	1.89
43	M	68	Tuberculosis	2.6	—	3.68	4.96
44	M	50	Tuberculosis	3.0	—	3.89	5.69

TNM staging was determined by histopathology or other imaging modalities. Tumor-to-normal tissue uptake ratios of ¹⁸F-FDG DHC are expressed as T/N_m. Tumor-to-normal tissue uptake ratios of ^99mTc-octreotide imaging are expressed as T/N_r.

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TABLE 2

Efficacy of ^99mTc-Octreotide for Detection of Primary Lesion and Lymph Node Involvement Compared with ¹⁸F-FDG

	¹⁸F-FDG DHC				^99mTc-Octreotide
Lesion location	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)	Sensitivity (%)	Specificity (%)	PPV (%)	NPV (%)
Primary lesion	100 (31–31)	46.1 (6–13)	83.8 (31–38)	100 (6–6)	100 (31–31)	75.7 (9–13)	90.1 (31–35)	100 (9–9)
Metastatic hilar or mediastinal LN	100 (20–20)	100 (11–11)	100 (20–20)	100 (11–11)	35 (7–20)	100 (7–7)	100 (7–7)	46 (11–24)

LN = lymph node.
Data are expressed as percentage, with range in parentheses.

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TABLE 3

Demographic and Clinical Staging of Study Population

Parameter	Value
No. of patients	44
Age range (y)	39–83
Women/men	12/32
Benign/malignant lesions	13/31
Surgery/biopsy/bronchoscopy/clinicoradiology	18/12/8/6
Lymph node adenopathy/no lymph node adenopathy	20/11
Clinical T factor for malignant lesions (1/2/3/4)	1/10/3/17
Clinical N status (0/1/2/3)	11/1/3/16
Distant metastasis/no distant metastasis	13/18
Contralateral lung intrametastasis/no lung intrametastasis	2/29
Pleural invasion/no pleural invasion	8/23
Bone metastasis/no bone metastasis	9/22
Brain metastasis/no brain metastasis	2/29