Chest
Volume 125, Issue 2, February 2004, Pages 494-501
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Clinical Investigations
NUCLEAR MEDICINE
The Utility of 99mTc Depreotide Compared With F-18 Fluorodeoxyglucose Positron Emission Tomography and Surgical Staging in Patients With Suspected Non-small Cell Lung Cancer

https://doi.org/10.1378/chest.125.2.494Get rights and content

Study objectives

The findings from conventional imaging modalities, such as chest CT, are frequently unreliable in patients with lung cancer. This study was designed to compare the relative diagnostic accuracies and utility of the two most widely used functional imaging examinations, F-18–2-fluoro-2-deoxyglucose (FDG) positron emission tomography (PET) and 99mTc depreotide scintigraphy, for the diagnosis and staging of lung cancer.

Design

Prospective, experimental investigation.

Setting

Academic medical center.

Patients

One hundred sixty-six subjects with suspected lung cancer were enrolled in the study.

Interventions

Whole-body and single-photon emission CT imaging of the chest was performed after IV administration of 99mTc depreotide. Attenuation-corrected FDG PET imaging was performed after IV administration of FDG. Image findings were compared with the biopsy results or clinical follow-up.

Measurements and results

In 157 subjects with evaluable lung lesions, the sensitivities and specificities for detecting malignant disease (95% confidence intervals) of FDG PET are 96% (90 to 98%) and 71% (54 to 85%), and of 99mTc depreotide are 94% (88 to 98%) and 51% (34 to 68%). In the 139 subjects with available complete staging data, FDG PET correctly staged 76 of 139 patients (55%), and 99mTc depreotide correctly staged 63 of 139 patients (45%).

Conclusions

The sensitivity for detection of lung cancer in the primary lesion is equally high for FDG PET and 99mTc depreotide. The specificity is superior for FDG PET. The staging accuracy of FDG PET and 99mTc depreotide is similar, but when read with the chest CT neither scintigraphic examination is sufficiently accurate to stage patients with non-small cell lung cancer.

Section snippets

Patients

After signing an informed consent statement approved by our Institutional Review Board for the study of human subjects, 166 subjects (48 women and 118 men; median age, 68 years; range, 40 to 87 years) who had abnormal chest CT scan results and were suspected of having operable and potentially curable lung cancer were prospectively enrolled into the study. All were scheduled to have a definitive diagnosis made and tumor staging performed by surgical intervention.

FDG PET Imaging and Interpretation

Each patient underwent a FDG PET

Primary Lung Lesion

Nine of the 166 subjects (5%) were excluded from analysis of the primary lesion because metastatic disease was proven before the biopsy of this lesion (n = 3), surgery was medically contraindicated (n = 2), or the patient refused any procedures to evaluate the lung lesion (n = 4). In the 157 subjects with complete data available, there were 122 malignant and 35 benign primary lesions. The median lesion size (average of the two longest dimensions on the chest CT) was 2.2 cm (range, 0.5 to 10.5

Discussion

Noninvasive testing results from patients with suspected lung cancer are frequently unreliable. Conventional imaging techniques have a limited diagnostic accuracy since interpretation relies principally on lesion size and other nonspecific findings.3 For this reason, newer imaging methods that do not rely solely on lesion size have been evaluated in patients with lung cancer.

We have found that FDG PET and 99mTc depreotide scans are equally sensitive for the detection of lung cancer at the

Conclusion

Our findings demonstrate that FDG PET and 99mTc depreotide have equally high sensitivities for the detection of lung cancer in the primary lesion. Therefore, since the likelihood of non-small cell lung cancer is low (particularly when the prevalence of cancer in the population is not > 50%) when either test result is negative, test selection should be based on other variables such as availability and convenience (99mTc depreotide, unlike FDG PET, uses standard nuclear medicine gamma cameras and

ACKNOWLEDGMENT

The authors thank Mitchell Thomas, CNMT; Jenifer Swearingen, RN; Amy Nibaur, RN; Dennis Sass, RN; Craig Larson, PA-C; John Richmond, CNMT; and Nicholas Rossi, MD, for assisting with this project.

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