Correlative 201Tl SPECT, MRI and ex vivo 201Tl uptake in detecting and characterizing cervical lymphadenopathy in head and neck squamous cell carcinoma.

The value of SPECT with 201Tl chloride, in combination with MRI (particularly short inversion-time inversion recovery [STIR] sequences that suppress fat signals) to detect and characterize cervical lymphadenopathies (nodes > or = 1 cm), and ex vivo lymph node 201Tl uptake were studied in patients with squamous cell carcinoma of the head and neck. METHODS: Preoperative SPECT and MRI, displayed in similar planes, were compared with the histologic findings in 15 neck dissection specimens from 12 patients with squamous cell carcinoma of the head and neck (9 with unilateral and 3 with bilateral neck dissection). Results were evaluated topographically with regard to the lymph node compartments (levels) of the neck. In addition, in 8 of these patients, the 201Tl activity of dissected lymph nodes of 10 neck sides was measured immediately after surgery in a gamma counter and expressed as percentage of the injected dose per gram tissue (%ID/g). RESULTS: Sixty-two lymph node levels were evaluated histologically. The high sensitivity of MRI (92% versus 71% for 201Tl SPECT), which correctly detected lymph node involvement in 22 of 24 levels, and the high specificity of 201Tl SPECT (92% versus 71% for MRI), which correctly characterized as negative 35 of 38 lymph node levels without metastasis on histology, led to a combined 201Tl SPECT/MRI accuracy of 92%. 201Tl SPECT was particularly effective in excluding involvement in 9 tumor-free neck levels with pathologically enlarged lymph nodes on MRI but failed to confirm involvement in 5 other tumor-positive levels. Mean 201Tl uptake in 53 lymph nodes with confirmed histologic involvement was significantly higher than uptake in 145 tumor-free lymph nodes (0.0043+/-0.0022 %ID/g versus 0.0023+/-0.0014 %ID/g, P = 0.0001), muscle and fat tissue but clearly lower than salivary gland uptake. CONCLUSION: Although 201Tl SPECT is not sensitive enough to be used as an independent imaging modality for staging of the neck, its correlative application with MRI appears to be an accurate method for the assessment of regional spread in head and neck squamous cell carcinoma. The ability of 201Tl SPECT to characterize neck lymphadenopathies detected by MRI appears to be based on the difference in 201Tl concentration found in lymph nodes with and without tumor involvement.     

201Tl SPECT in the detection of mediastinal lymph node metastases from lung cancer

201Tl SPECT was performed to detect mediastinal involvement in 80 patients with lung cancer who underwent surgery within a week after the SPECT study. Out of 29 patients with mediastinal involvement 16 (55%) were positive on the 201Tl early scan at 15 min postinjection and 22 (76%) were positive on the delayed scan at 3 h. These metastatic lymph nodes tended to be visualized much better on the delayed scan. In all patients with true positive results on the delayed scan, the mediastinal lymph nodes were plural, with a lesion of more than 14 mm in size. Seven false negative cases were found to have metastatic lesions less than 12 mm in size. Both the early and delayed scans showed false positive accumulation in six of 51 patients without mediastinal involvement (specificity 88%). Thus the overall accuracy for the delayed scan was 84%. The 201Tl delayed SPECT is thought to be a good noninvasive method for assessing mediastinal lymph node metastases from lung cancer.     

Relationship between cancer cell proliferation and thallium-201 uptake in lung cancer

Although thallium-201 (201Tl) uptake is related to perfusion in many normal tissues, the biologic rationale for 201Tl uptake in tumors is uncertain. To determine if tumor uptake is related to cell proliferation, we correlated the relative retention of 201Tl in lung tumors with expression of Ki-67, an indicator of cell proliferation. METHODS: Sixty patients with lung tumors, included small cell carcinoma (n = 8) and non-small cell carcinoma (n = 52), underwent 201Tl single photon emission computed tomography (SPECT) imaging. The 201Tl lesion uptake was determined on early and delayed images and the radiotracer retention index (RI) was calculated. Tumor specimens were obtained at surgery or bronchoscopy. The cell proliferation ratio was estimated with MIB-1, a monoclonal antibody that recognized the nuclear antigen Ki-67. RESULTS: The average 201Tl index was 2.13+/-0.61 (early) and 2.46+/-0.83 (delayed). The average RI was 17.44+/-35.01. Overall, the 201Tl index (delayed) and the cancer cell proliferation were correlated (r = 0.70, p < 0.0001). Of interest, there was a significant correlation (r = 0.872, p < 0.0005) between the 201Tl index on delayed images and the cell proliferation ratio in patients with small cell but not non-small cell lung carcinoma. The 201Tl index (delayed) was significantly higher (p < 0.0001) in patients with small cell lung carcinoma than in patients with non-small cell lung carcinoma. CONCLUSION: 201Tl imaging appears to be useful for evaluating patients with small cell lung carcinoma but not non-small lung carcinoma, and is correlated with the monoclonal antibody MIB-1, a marker of cell proliferation.     

磁共振短时间反转恢复序列技术对非小细胞肺癌患者纵隔淋巴结转移的评估分析

目的 探讨非小细胞肺癌患者采用磁共振短时间反转恢复序列技术(MRI-STIR)诊断纵隔淋巴结转移的临床价值.方法 选取2019年1月至2020年12月期间于本院进行手术治疗的70例非小细胞肺癌患者作为研究对象,所有患者均在术前进行MRI-STIR检查,以术后病理结果为金标准,分析MRI-STIR对非小细胞肺癌患者纵隔淋...     

串珠征在周围型小细胞肺癌中的诊断价值

目的：探讨串珠征的形成机制,评价其在周围型小细胞肺癌(SCLC)、周围型肺腺癌及周围型肺鳞癌中的鉴别诊断意义。方法收集病理证实的周围型 SCLC 78例、周围型肺腺癌69例、周围型肺鳞癌33例,分别统计串珠征的阳性率、纵隔淋巴结的转移率及纵隔淋巴结大于肺原发灶的比例,对相关数据进行统计分析。结果78例周围型 SCLC中10例串珠征阳性(12.8%),且纵隔淋巴结均大于肺原发灶;78例中63例纵隔淋巴结转移(80.8%),42例纵隔淋巴结大于肺原发灶(53.8%)。69例周围型实性肺腺癌中,无1例出现串珠征,25例纵隔淋巴结转移(36.2%),2例纵隔淋巴结大于原发灶(2.9%)。33例周围型肺鳞癌中1例串珠征阳性(2.8%),该例肺门淋巴结明显小于肺原发灶,33例中13例纵隔淋巴结转移(39.4%),6例纵隔淋巴结大于原发灶(16.7%)。经统计分析,串珠征在周围型 SCLC与周围型肺鳞癌中差异无统计学意义,周围型 SCLC与周围型肺腺癌、肺鳞癌在纵隔淋巴结转移率及纵隔淋巴结大于肺原发灶的阳性率差异均有统计学意义。结论串珠征在一定程度上反映 SCLC 的生物学特性,在周围型SCLC与周围型肺腺癌、肺鳞癌的鉴别诊断中有重要价值,应结合纵隔淋巴结大小。     

Mediastinal lymph node involvement in non-small cell lung cancer: evaluation with 99mTc-tetrofosmin SPECT and comparison with CT.

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 (99m)Tc-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 (99m)Tc-tetrofosmin injection (740 MBq intravenously). The metastatic involvement of mediastinal nodes was assessed by histologic examination after mediastinoscopy or thoracotomy. Both chest CT and (99m)Tc-tetrofosmin scintigraphy were performed within 2 wk before the surgical staging. RESULTS: Metastatic mediastinal lymph nodes were found in 35 patients. (99m)Tc-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 (99m)Tc-tetrofosmin uptake in the mediastinum was not always present on SPECT images. (99m)Tc-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 > or =1 cm), with an accuracy (91.7%) significantly higher (P < 0.05) than that of CT (66.7%). CONCLUSION: (99m)Tc-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.     

18F-FDG PET-CT显像在预测肺癌淋巴结分期中的价值

目的:探究18F-FDG PET-CT显像在肺癌患者淋巴结分期中的预测价值。方法:以35例经手术病理证实为肺癌患者的PET-CT资料及临床资料为研究对象。在PET-CT原发灶及纵隔淋巴结各区最浓聚的部位勾画感兴趣区,得出SUVmax.以淋巴结转移进行分组,采用t检验、Wilcoxon rank-sum检验及四格表资料的Fisher确切概率法分析组间淋巴结SUVmax、淋巴结与原发灶SUVmax的比值(SUVratio)及临床特征的差异。用ROC曲线对PET/CT的预测价值进行分析。结果:患者年龄、性别、吸烟史、组织类型与肺门、纵隔淋巴结转移无显著相关(P>0.05)。转移淋巴结的SUVmax较非转移淋巴结显著升高,差异有统计学意义(P<0.05),而淋巴结的SUVratio与淋巴结转移无明显相关(P>0.05)。取淋巴结SUVmax的最佳阈值,假阴性患者中的肺癌原发灶SUVmax偏低,假阳性患者比假阴性患者中的吸烟率高,但不具有显著统计学意义(P>0.05)。结论:淋巴结SUVmax可以为临床判断淋巴结转移提供定量指标。结合患者的临床病理特征判断淋巴结的转移可能从--定程度上减少假阳性率及假阴性率。     

18F-FDG accumulation with PET for differentiation between benign and malignant lesions in the thorax.

Recent reports have indicated the value and limitations of (18)F-FDG PET and (201)Tl SPECT for determination of malignancy. We prospectively assessed and compared the usefulness of these scintigraphic examinations as well as (18)F-FDG PET delayed imaging for the evaluation of thoracic abnormalities. METHODS: Eighty patients with thoracic nodular lesions seen on chest CT images were examined using early and delayed (18)F-FDG PET and (201)Tl-SPECT imaging within 1 wk of each study. The results of (18)F-FDG PET and (201)Tl SPECT were evaluated and compared with the histopathologic diagnosis. RESULTS: Fifty of the lesions were histologically confirmed to be malignant, whereas 30 were benign. On (18)F-FDG PET, all malignant lesions showed higher standardized uptake value (SUV) levels at 3 than at 1 h, and benign lesions revealed the opposite results. Correlations were seen between (18)F-FDG PET imaging and the degree of cell differentiation in malignant tumors. No significant difference in accuracy was found between (18)F-FDG PET single-time-point imaging and (201)Tl SPECT for the differentiation of malignant and benign thoracic lesions. However, the retention index (RI) of (18)F-FDG PET (RI-SUV) significantly improved the accuracy of thoracic lesion diagnosis. Furthermore, (18)F-FDG PET delayed imaging measuring RI-SUV metastasis was useful for diagnosing nodal involvement and it improved the specificity of mediastinal staging. CONCLUSION: No significant difference was found between (18)F-FDG PET single-time-point imaging and (201)Tl SPECT for the differentiation of malignant and benign thoracic lesions. The RI calculated by (18)F-FDG PET delayed imaging provided more accurate diagnoses of lung cancer.     

Evaluation of Tl-201 SPECT for monitoring the treatment of pulmonary and mediastinal tumors

Tl-201 single photon emission computed tomography (SPECT) was performed in 88 patients with pulmonary or mediastinal tumors in order to evaluate its usefulness for the detection of disease and for the assessment of the effect of treatment. We also examined mediastinal and hilar lymph node metastasis from lung cancer. Tl-201 SPECT showed abnormal accumulation on delayed images in all lung cancer patients with tumor diameters more than 12 mm. In the 14 operated lung cancer patients, mediastinal and hilar lymph node metastases with diameters of more than 15 mm were imaged, but one with a diameter of 9 mm was missed. The retention index (RI) was 27.52±31.58 in malignant tumors and ?13.67 ± 8.15 in benign tumors (p < 0.05). The RI was significantly lower after treatment than before treatment. The interval until tumor recurrence or reactivation tended to be longer in patients who showed a significant decrease in the RI after therapy. These findings suggest the usefulness of the RI as an index of therapeutic efficacy.     

低剂量CT灌注联合影像组学评估非小细胞肺癌的纵隔淋巴转移

目的:探究基于低放射剂量CT灌注影像提取CT灌注参数以及影像组学参数联合评估非小细胞肺癌(NSCLC)纵隔淋巴转移的效能。方法:纳入2017年3月-2020年5月经病理证实为纵隔淋巴转移的NSCLC患者以及非纵隔淋巴转移的NSCLC患者,所有患者于术前行低剂量CT灌注扫描。术中系统性清扫患者N1及N2站淋巴结,并取肿瘤组织以及淋巴结分别做微血管密度免疫组化检验以及淋巴结病理检测。将所有患者按照分层随机的原则以7:3的比例分为训练组和验证组。诊断医师基于CT灌注图像进行肿瘤感兴趣区域分割,并提取CT灌注参数:血流量(BF)、血容量(BV)、平均通过时间(MTT)、血管通透性(PMB)以及396个影像组学参数。基于训练组人群的影像组学特征降维后采用LASSO构建影像组学标签Radscore,联合Radscore以及CT灌注参数构建多元逻辑回归模型评估非小细胞肺癌患者纵隔转移的可能性。结果:经过特征降维后,利用LASSO构建Radscore,选择惩罚系数log(λ)=0.867,共计7个影像组学。Radscore在训练组中和验证组中评估NSCLC纵隔淋巴细胞转移时具有较好的诊断效能(0.840 vs 0.841);训练组中纵隔转移和非纵隔转移患者的CT灌注参数:MTT以及BV具有统计学差异,且在训练组和验证组中的诊断效能高于随机诊断[(0.687 vs 0.698>0.500)(0.672 vs 0.698>0.500)]。联合Radscore以及CT灌注参数BV和MTT构建的联合模型Image model的诊断效能在训练组中高于Radscore、BV、MTT(P=0.378、0.014、0.010),在验证组中低于Radscore,高于BV、MTT(P=0.563、0.631、0.093)。Image model Hosmer-Lemeshow统计结果显示模型与实际观察情况无显著差异,可拟合(P>0.05)。结论:CT灌注参数与影像组学标签可用以评估非小细胞肺癌患者纵隔淋巴是否转移,同时联合CT灌注参数与影像组学标签可构建联合模型评估纵隔淋巴是否转移。     

Imaging of regional lymph node metastases with 99mTc-depreotide in patients with lung cancer

Purpose The aim of this study was to evaluate the clinical usefulness of scintigraphy with ^99mTc-depreotide in the assessment of loco-regional nodal spread in patients with suspected lung cancer in comparison with computed tomography (CT).Methods Eighty-six patients were investigated with single-photon emission computed tomography (SPECT) of the thorax after i.v. injection of 740 MBq ^99mTc-depreotide. The results were evaluated in conjunction with a thoracic CT scan in all 86 patients with 204 lymph node stations. The scintigraphic results were correlated with cytological (38), histological (20) or clinical–radiological (146) findings and compared with CT. The quantitative evaluation of depreotide uptake was performed on 48 cytologically or histologically verified nodal stations from 28 patients by SPECT using region of interest analysis with four different reference regions.Results ^99mTc-depreotide scintigraphy for all 204 investigated lymph node stations had a sensitivity of 99% and a negative predictive value of 98% in determining lymph node involvement. Scintigraphy and CT showed the same level of accuracy, 76.4%. CT findings had a higher positive predictive value but a lower negative predictive value compared to ^99mTc-depreotide scintigraphy. The quantitative evaluation of depreotide uptake in lymph nodes using vertebra as a reference region showed that a cut-off level of 0.56 excludes malignant involvement of lymph nodes, while a cut-off level of 1.66 excludes benign disease in lymph nodes. About 73% of all investigated lymph node stations showed uptake values between these cut-off levels.Conclusion Absence of ^99mTc-depreotide uptake on scintigraphic imaging can exclude regional lymph node involvement with a high degree of probability and may be useful in clinical practice. The quantitative evaluation of depreotide uptake in regional lymph nodes did not increase the diagnostic accuracy of the method in general but did elucidate the lymph node status in some patients.     

术前CT诊断NSCIC纵膈淋巴结转移的研究

目的：探讨术前CT检查对非小细胞肺癌（non-small cell lung cancer NSCLC）患者肺门纵隔淋巴结转移的诊断价值。方法：分析我院52例行手术治疗的NSCLC患者,均有术前CT肺门纵隔淋巴结描述以及术后病理检查淋巴结转移的结果。结果：CT检查对NSCLC肺门纵隔淋巴结转移诊断的灵敏性为67.4%、特异性为84.4%和诊断符合率为80.8%。结论：CT是评价NSCLC患者肺门纵隔淋巴结转移的重要检查手段,根据淋巴结直径大小能够提供有效的纵隔淋巴结转移信息。     

Thallium-201 SPECT in advanced non-small cell lung cancer: In relation with chemotherapeutic response,survival, distant metastasis and p53 status

PURPOSE: The aim of this study was to evaluate the relationship between 201Tl tumor uptake, chemotherapeutic response, metastasis, p53 status and survival in non-small cell lung cancer (NSCLC). METHODS: A total of 23 patients underwent 201Tl SPECT. In 9 patients, 2nd 201Tl SPECT study were performed 1 week after the 3rd cycle of chemotherapy (ChT), and early (ER) and delayed (DR) tumor/normal lung ratios and retention indices (RI) were obtained. In 15 patients p53 status was assayed with immuno-histochemical staining. The patients were divided into subgroups after the 3rd cycle of ChT; responders [R(+) (n = 10)] and non-responders [R(-) (n = 13)], distant metastasis [(M1) n = 11] and [(M0) n = 12], and mutant p53 status [p(+) n = 7, p53(-) n = 8]. RESULTS: The differences for ER, DR and RI values between all of the subgroups were not statistically significant. ER and DR of responders decreased significantly after ChT; from to 2.46 to 1.36 (p = 0.04) and 2.29 to 1.53 (p = 0.04), respectively. In the non-responder group, both ER and DR slightly increased after ChT (p > 0.05). CONCLUSION: Our results suggest that in NSCLC, there was a weak correlation between higher 201Tl ratios and positive response to chemotherapy, absence of distant metastasis, and p53(-) status. Significant 201Tl uptake decrease after chemotherapy indicates that delayed 201Tl uptake can be used in evaluating the chemotherapeutic response.     

201Tl scintigraphy in the staging of lung cancer, breast cancer and lymphoma

To evaluate 201Tl in the detection of the primary tumour, lymph node involvement and mediastinal spread we have studied a total of 188 patients with histologically proven lung cancer, breast cancer or malignant lymphoma. Ten patients with benign lung disease were also examined. Static images were performed 20 min after intravenous injection of 75 MBq of thallous (201Tl) chloride. The results were compared with those of standard staging procedures including CT scanning and mediastinal exploration. Thallium-201 imaging was highly sensitive in detecting the primary tumour (lung cancer 86%, breast carcinoma 100%, lymphoma 85%), but showed low sensitivity in detecting mediastinal spread or lymph node involvement. Thallium-201 uptake was also observed in active sarcoidosis (one case) and active TB (two cases). We conclude that 201Tl imaging is unlikely to have a clinically useful role in the diagnosis or staging of lung cancer, breast cancer or lymphoma.     

Study of the lymph flow of the cardia by endoscopic RI-lymphography with SPECT

Endoscopic RI-lymphography was performed in 29 patients, with single photon emission computed tomography (SPECT) also performed in 19 of them. The lymph flow from the cardia was directly evaluated in lymphograms and compared with the RI uptake of each lymph node and the incidence of lymph node metastasis of previously resected carcinoma of the cardia in patients according to the location of the lymph node. Endoscopic RI-lymphography performed in combination with SPECT was considered to be highly useful for imaging lymph flow of the cardiac region. SPECT and RI-lymphography indicated rich lymph flow from the cardia to the periaortic region, and this finding was consistent with the incidence of lymph node metastasis according to the location of the lymph node in patients who had previously undergone resection of cancer of the cardia. Careful examination for metastasis to lymph nodes around the abdominal aorta was considered to be necessary, especially in patients with carcinoma of the cardia.     

Evaluation of uptake and release of technetium-99m MIBI SPECT of pulmonary and mediastinal lesions

We evaluated the uptake and release of Tc-99m MIBI in 7 benign and 30 malignant pulmonary and mediastinal lesions. Of the 37 patients, 13 underwent surgery; malignant involvement was examined in 21 mediastinal lymph nodes. Tl-201 SPECT was also performed in 10 patients. Tc-99m MIBI SPECT studies were performed on transverse SPECT images acquired 30 minutes and 3 hours after intravenous injection of 600 MBq of Tc-99m MIBI with three gamma camera detectors (GCA-9300A). Regions of interest were set in the area of abnormal uptake of Tc-99m MIBI and in an area of normal tissue in the contralateral lung. The uptake ratio of the lesion in the contralateral normal lung was obtained on the early image (early ratio; ER) as well as the delayed image (delayed ratio; DR). The benign lesions showed significantly lower ER (1.6 ± 0.3) and DR (1.4 ± 0.4) than the malignant lesions (1.9 ± 0.5 and 1.8 ± 0.5, respectively; both p < 0.05). There was no significant difference in the retention index (RI), calculated as RI = (DR ? ER)/ER × 100. The DR obtained with Tl-201 SPECT images was significantly higher than that obtained with Tc-99m MIBI SPECT (p < 0.05). For the detection of mediastinal lymph node metastases, the early images showed sensitivity, specificity, and accuracy of 85.7%, 100%, and 95.2%, respectively, for the delayed images these values were 85.7%, 92.9%, and 90.5%, respectively. These results suggest that the uptake ratio of Tc-99m MIBI is a useful index in assessing benign or malignant pulmonary and mediastinal lesions.     

Thallium-201 SPECT with triple-headed gamma camera for differential diagnosis of small pulmonary nodular lesion 20 mm in diameter or smaller

AIM: Although thallium-201 (201Tl) has been used for the diagnosis of lung cancer, its detectability of small pulmonary nodules is not known. The aim of this study was to evaluate the ability of 201Tl SPECT for the differential diagnosis for the pulmonary nodules 20 mm in diameter or smaller. METHODS: 201Tl SPECT was performed in 31 patients suspected of having primary lung cancer. The final diagnosis was established by histology, and tumor size was 10 to 20 mm in diameter. Twenty of 31 patients had malignant tumors, including squamous cell lung cancer (n = 5), adenocarcinoma (n = 14) and small cell lung cancer (n = 1), but in none of them was there mediastinal lymphnode involvement. RESULTS: Ten of 20 malignant tumors and 1 of 11 benign lesions demonstrated significant 201Tl uptake, so that the positive predictive value, negative predictive value, sensitivity and specificity for the diagnosis of lung cancer were 90.9% (10/11), 50.0% (10/20), 50.0% (10/20) and 90.9% (10/11), respectively. CONCLUSION: These data suggest that sensitivity for detecting lung cancer 20 mm or less in diameter may be insufficient, but even in patients with small pulmonary nodules, a positive 201Tl result is highly predictive of lung cancer.     

Relationship between cancer cell proliferation, tumour angiogenesis and 201Tl uptake in non-small cell lung cancer

PURPOSE: To investigate whether 201Tl uptake is associated with cell proliferation and angiogenesis in non-small-cell lung carcinoma (NSCLC). METHODS: Eighty-four patients with scheduled NSCLC underwent 201Tl single photon emission computed tomography (SPECT) imaging: 15 min (early scan) and 240 min (delayed scan) after intravenous injection of 111 MBq of 201Tl chloride. 201Tl indices were calculated on early images (early ratio: ER) and delayed images (delayed ratio: DR). The retention index (RI) was also calculated from these two parameters. Using surgically resected cancer specimens (54 adenocarcinoma, 24 squamous cell carcinoma (SCC), six large-cell carcinoma), immunohistochemical stains for both Ki-67 (MIB-1 index) and CD34 were performed to examine the proliferative activity and the micro-vessel density (MVD), respectively. RESULTS: The mean value of 201Tl index was 1.69+/-0.77 (ER) and 2.31+/-1.08 (DR). The average RI was 42.6+/-42.9%, respectively. Both DR and RI positively correlated with MIB-1 index (r = 0.68, P < 0.05 and r = 0.52, P < 0.05). When we analyse adenocarcinoma and SCC separately, there was a significant positive correlation (r = 0.62, P < 0.05) between RI and MIB-1 index in adenocarcinoma but not in SCC (r = 0.20, P = NS). The value of ER positively correlated with MVD (r = 0.75, P < 0.05). It demonstrated strong positive correlation with both histological types (adenocarcinoma: r = 0.80, P < 0.05, SCC: r = 0.66, P < 0.05). CONCLUSION: 201Tl SPECT imaging is effective non-invasive method for assessing both the proliferation and the angiogenesis in NSCLC. Both DR and RI are useful indicators for assessing cancer cell proliferation in lung adenocarcinoma. ER is a useful marker for assessing the tumour angiogenesis in NSCLC.     

非小细胞肺癌30例术中应用~(99m)Tc标记前哨淋巴结的临床观察

目的探讨非小细胞肺癌术中应用99mTc探测肺癌前哨淋巴结,以提高术中清除前哨淋巴结的准确性。方法 30例非小细胞肺癌患者,术中将99mTc硫胶体溶液在肺部肿瘤环周的4～6个部位分别注射,用便携式γ射线探测器探测肺门及纵隔各部位淋巴结的放射活性计数值。常规行肺癌肺叶切除、淋巴结清除术并行常规病理检查。结果 30例患者共清除淋巴结395枚,其中前哨淋巴结即阳性转移淋巴结112枚,阳性转移率为28.3%。前哨淋巴结的99mTc放射活性计数值为15321.85±5945.28,阴性淋巴结的计数值为8479.26±3201.37(P<0.01)。结论对于非小细胞肺癌患者,术中应用99mTc标记前哨淋巴结能够更准确地提示肺癌纵隔转移淋巴结,有效提高转移淋巴结的检出率。     

Comparative evaluation of Tc-99m MIBI and Tl-201 chloride SPECT in non-small-cell lung cancer mediastinal lymph node metastases

PURPOSE: To compare the utility of Tc-99m MIBI SPECT and Tl-201 chloride SPECT for presurgical assessment of lung cancer mediastinal lymph node metastases. METHODS: Forty-one patients with non-small-cell lung cancer underwent dual-isotope imaging with Tl-201 chloride and Tc-99m MIBI and were evaluated for mediastinal lymph node involvement. RESULTS: The sensitivity rates of early and delayed Tc-99m MIBI SPECT and of early and delayed Tl-201 chloride SPECT for detecting mediastinal nodal metastases were 69%, 69%, 92%, and 92%, respectively. The corresponding specificity rates were 96%, 96%, 93%, and 96%. CONCLUSION: Tl-201 chloride SPECT is superior to Tc-99m MIBI SPECT when used to detect mediastinal lymph node metastases in patients with non-small-cell lung cancer.