RT Journal Article SR Electronic T1 Mediastinal Lymph Node Involvement in Non–Small Cell Lung Cancer: Evaluation with 99mTc-Tetrofosmin SPECT and Comparison with CT JF Journal of Nuclear Medicine JO J Nucl Med FD Society of Nuclear Medicine SP 1219 OP 1224 VO 44 IS 8 A1 Orazio Schillaci A1 Angela Spanu A1 Francesco Scopinaro A1 Francesco Monteleone A1 Maria Elisabetta Solinas A1 Patrizia Volpino A1 Pietro Pirina A1 Pietro Marongiu A1 Vincenzo Cangemi A1 Giuseppe Madeddu YR 2003 UL http://jnm.snmjournals.org/content/44/8/1219.abstract AB In patients with non–small cell lung cancer (NSCLC), surgical resection offers the best chance of cure. The preoperative assessment of mediastinal lymph node involvement is crucial to selecting those patients for whom surgery is indicated. Methods: To evaluate the possible clinical role of 99mTc-tetrofosmin scintigraphy in the presurgical detection of mediastinal node metastases from NSCLC, we performed a prospective comparative study with CT on 83 patients (48 men, 35 women; age range, 38–81 y) with primary NSCLC (36 adenocarcinomas, 39 epidermoid squamous cell carcinomas, and 8 large cell anaplastic carcinomas). They underwent chest SPECT 20 min after 99mTc-tetrofosmin injection (740 MBq intravenously). The metastatic involvement of mediastinal nodes was assessed by histologic examination after mediastinoscopy or thoracotomy. Both chest CT and 99mTc-tetrofosmin scintigraphy were performed within 2 wk before the surgical staging. Results: Metastatic mediastinal lymph nodes were found in 35 patients. 99mTc-Tetrofosmin imaging in assessing the mediastinal involvement yielded a sensitivity of 85.7%, a specificity of 89.6%, and an accuracy of 88.0%; CT results were 68.6%, 75.0%, and 72.3%, respectively. SPECT accuracy was significantly higher than CT accuracy (P < 0.05). However, precise anatomic localization of 99mTc-tetrofosmin uptake in the mediastinum was not always present on SPECT images. 99mTc-Tetrofosmin SPECT precisely detected the presence or absence of lymph node metastases in 33 of the 36 patients with positive CT findings (enlarged mediastinal nodes with a short axis ≥ 1 cm), with an accuracy (91.7%) significantly higher (P < 0.05) than that of CT (66.7%). Conclusion: 99mTc-Tetrofosmin SPECT is a useful presurgical noninvasive method to assess mediastinal lymph node involvement in NSCLC. In particular, it could play a clinical role in reducing the number of invasive staging surgical procedures in selected patients, especially in those with enlarged lymph nodes at CT. Fusing SPECT with CT images could further improve the interpretation of the scintigraphic data.