Advantages of 99m Tc-3PRGD 2 SPECT over CT in the preoperative assessment of lymph node metastasis in patients with esop
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ORIGINAL ARTICLE
Advantages of 99mTc-3PRGD2 SPECT over CT in the preoperative assessment of lymph node metastasis in patients with esophageal cancer Ningning Lv1 · Shi Gao1 · Lin Bai1 · Bin Ji1 · Jinru Xue2 · Xiaoguang Ge1 · Bin Chen1 Received: 18 July 2018 / Accepted: 9 September 2018 © The Japanese Society of Nuclear Medicine 2018
Abstract Background Our study was designed to compare the diagnostic efficacies of integrated 99mTc-HYNIC-PEG4-E[PEG4c(RGDfK)]2 (99mTc-3PRGD2) single-photon emission computed tomography (SPECT) images and computed tomography (CT) images in lymph node metastasis in the patients with esophageal cancer. Methods From September 2015 and May 2018, 32 patients with histologically proven primary esophageal carcinoma underwent both 99mTc-3PRGD2 SPECT and CT scans followed by esophagectomy with lymph node dissection. The results of reviewing 99mTc-3PRGD2 SPECT and CT images for the lymph node metastasis were compared in relation with pathologic findings. Results During surgery, a total of 168 lymph nodes were dissected in 32 patients, of which 42 node groups in 18 patients were malignant on histologic examination. Preoperative nodal staging was compared with postoperative histopathological staging, The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 99mTc-3PRGD2 SPECT for lymph nodes were 80.95%, 86.51%, 85.12%, 66.67%, and 93.16% on per-node basis, respectively; compared with 59.52%, 73.02%, 69.64%, 42.37%, and 84.40% for CT (p = 0.034, 0.008, 0.005, 0.011, and 0.038, respectively). 70.59% (12/17) falsenegative interpretations and 50% (17/34) false-positive interpretations on CT were corrected by 99mTc-3PRGD2 SPECT. 37.5% false-negative interpretations on 99mTc-3PRGD2 SPECT were corrected by CT. 11.90% (5/42) positive lymph nodes and 13.49% (17/126) negative nodes at pathology were incorrectly diagnosed both by 99mTc-3PRGD2 SPECT and CT. The accuracy of 99mTc-3PRGD2 SPECT (87.50%, 28/32) was significantly higher than that of CT (62.50, 20/32; p = 0.022) on per-patient basis. 99mTc-3PRGD2 SPECT showed significantly higher sensitivity and accuracy in the neck and upper thoracic regions than CT. For nodal staging, 99mTc-3PRGD2 SPECT was correct in 78.12% (25/32) of the patients, whereas CT was correct in 53.12% (17/32), p = 0.037. Conclusion 99mTc-3PRGD2 SPECT is more accurate than CT for preoperative assessment of lymph node metastasis in esophageal cancer and may be helpful in determining the therapeutic plan. Keywords 99mTc-3PRGD2 · Esophageal cancer · SPECT · CT · Lymph node
Introduction
* Shi Gao [email protected] * Bin Chen [email protected] 1
Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China
2
Esophageal cancer continues to be a major public health problem in China. The Chinese Cancer Society states that 477,900 million cases of esophageal cancer were diagnosed in 2015, which was estim
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