18F-FLT与18F-FDG PET/CT对非小细胞肺癌淋巴结分期的比较

目的 比较3′-脱氧-3′-18F-FLT与18F-FDG PET/CT对NSCLC淋巴结分期的诊断价值,探讨肿瘤FLT和FDG摄取与细胞周期蛋白Cyclin D1表达的相关性.方法 选择手术治疗的NSCLC患者31例,男22例,女9例,年龄38～84岁.术前2周内行18F-FLT和18F-FDG PET/CT检查,术后行病理和转移淋巴结的免疫组织化学Cyclin D1检测.以病理诊断为“金标准”,评价18F-FLT和18F-FDG PET/CT显像对NSCLC的诊断价值.应用SPSS 12.0软件,计数资料行,检验,组间SUV.差异行方差分析,SUV.与Cyclin D1的表达行直线相关分析.结果 FLT和FDG PET/CT对NSCLC原发灶诊断的灵敏度分别为74.2％(23/31)和93.5％ (29/31),二者差异有统计学意义(x2=4.29,P =0.038).FLT PET/CT对NSCLC区域淋巴结诊断的灵敏度、特异性、准确性和阳性预测值分别为65％(39/60)、98％ (291/296)、93％(330/356)和85％(39/46),FDG PET/CT则分别为85％(51/60)、84％(249/296)、84％(300/356)和52％(51/98),二者差异有统计学意义(x2值分别为6.40、32.89、12.40、14.32和2.98,P均＜0.05).对于N分期,FLT PET/CT能使77.4％(24/31)的NSCLC患者分期正确,6.5％(2/31)的患者分期过高(假阳性),16.1％(5/31)的患者分期过低(假阴性);而FDG PET/CT相应数据则分别为77.4％(24/31)、16.1％(5/31)和6.5％(2/31).原发灶18F-FLT SUVmax与肿瘤组织Cyclin D1表达呈正相关(r=0.644,P＜0.01),FDG SUVmax则无相关性(r=0.293,P＞0.05).临床分期越晚,FLT SUVmax越高(F=12.2,P＜0.05),但FDG SUVmax则无此趋势(F=3.1,P＞0.05)；二者在不同病理类型、分化程度之间差异无统计学意义(F=1.1、0.6、0.8和1.1,P均＞0.05).结论 与FDG PET/CT相比,FLT PET/CT对NSCLC淋巴结分期过低的患者多,而分期过高的患者少；对区域淋巴结诊断灵敏度降低,但有更高的特异性、准确性和阳性预测值.肿瘤FLT摄取与细胞周期蛋白Cyclin D1的表达有相关性.

Comparison of nodal staging between 18F-FLT and lSF-FDG PET/CT in patients with non-small cell lung cancer

Objective To compare the efficiency of is F-FLT and is F-FDG PET/CT in lymph node staging for patients with NSCLC, and to explore the correlation between FLT/FDG uptake and Cyelin D1 expression. Methods Thirty-one patients （22 men and 9 women; ranging from 38 to 84 y） with NSCLC underwent both ^18F-FLT and ISF-FDG PET/CT scans before surgical resection （t,lmnr t; A 1 1.node dissection）. Histopathologic results were considered the gold standard. Cyclin D1 immunohistochemistry was regarded as the tumor cell proliferation index. Analysis of variance, 22 test and linear correlation were performed using SPSS 12.0. Results The sensitivity, specificity, accuracy and positive predictive value of 18F-FLT PET/CT for lymph node staging were 65% （39/60）, 98% （291/296）, 93% （330/356） and 85% （39/46） , and for 18F-FDG PET/CT, were 85% （51/60）, 84% （249/296） , 84% （300/356） and 52% （51/98 ） , respectively （X2 = 6.40, 32.89, 12.40, 14.32, 2. 98, all P 〈 0.05 ）. For N staging, 77.4% （24/31） patients were correctly staged, 6.5% （2/31） were overstaged, and 16.1% （5/31） were understaged by 18 F-FLT PET/CT; while those results for 18 F-FDG PET/CT were 77.4% （24/31） , 16.1% （5/31） and 6.5% （2/31）, respectively. Tumor FLT SUVm,x was correlated significantly with Cyclin D1 expression （r = 0.644, P 〈 0.01 ）, but FDG SUVm.x was not （r = 0. 293, P 〉 0.05）. FLT SUVmax in late stages was higher than that in early stages （ F = 12.2, P 〈 0.05 ）. However, there was no significant difference between FDG SUVm,xOf different stages （F = 3.1, P 〉 0.05 ）. There was no significant difference between SUV of FLT and FDG among different pathological types （ F = 1.1, 0.6, both P 〉 0.05 ） and differentiation（ F = 0.8, 1.1, both P 〉 0.05 ）. Conclusions NSCLC patients are more frequently understaged but less frequently overstaged during N staging by lSF-FLT PET/CT compared with lSF-FDG PET/CT. ^18F- FLT PET/CT has lower sensitivity, but higher specificity, aceuracy and positive predictive value for N staging of NSCLC. FLT uptake and Cyclin D1 expression is eorrelated in NSCLC.