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Annals of Nuclear Medicine

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01-01-2019 | Original Article

Advantages of ^99mTc-3PRGD₂ SPECT over CT in the preoperative assessment of lymph node metastasis in patients with esophageal cancer

Authors: Ningning Lv, Shi Gao, Lin Bai, Bin Ji, Jinru Xue, Xiaoguang Ge, Bin Chen

Published in: Annals of Nuclear Medicine | Issue 1/2019

Abstract

Background

Our study was designed to compare the diagnostic efficacies of integrated ^99mTc-HYNIC-PEG4-E[PEG4-c(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) false-negative 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.

Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. Cancer statistics in China, 2015. Ca Cancer J Clin. 2016;66(2):115–32.CrossRefPubMed

Eloubeidi MA, Desmond R, Arguedas MR, Reed CE, Wilcox CM. Prognostic factors for the survival of patients with esophageal carcinoma in the U.S.: the importance of tumor length and lymph node status. Cancer. 2002;95(7):1434–43.CrossRefPubMed

Mariette C, Piessen G, Briez N, Triboulet JP. The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent. Ann Surg. 2008;247(2):365–71.CrossRefPubMed

Tachimori Y, Ozawa S, Numasaki H, Ishihara R, Matsubara H, Muro K, et al. Comprehensive registry of esophageal cancer in Japan, 2011. Esophagus. 2018;15(3):127–52.CrossRefPubMedPubMedCentral

Vilgrain V, Mompoint D, Palazzo L, Menu Y, Gayet B, Ollier P, et al. Staging of esophageal carcinoma: comparison of results with endoscopic sonography and CT. Ajr Am J Roentgenol. 1990;155(2):277–81.CrossRefPubMed

Goei R, Lamers RJ, Engelshove HA, Oei KT. Computed tomographic staging of esophageal carcinoma: a study on interobserver variation and correlation with pathological findings. Eur J Radiol. 1992;15(15):40–4.CrossRefPubMed

Tio TL, Coene PP, Schouwink MH, Tytgat GN. Esophagogastric carcinoma: preoperative TNM classification with endosonography. Radiology. 1989;173(2):411–7.CrossRefPubMed

Zhang X, Watson DI, Lally C, Bessell JR. Endoscopic ultrasound for preoperative staging of esophageal carcinoma. Surg Endosc. 2005;19(12):1618–21.CrossRefPubMed

Tsai JA, Celebioglu F, Lindblad M, Lörinc E, Nilsson M, Olsson A, et al. Hybrid SPECT/CT imaging of sentinel nodes in esophageal cancer: first results. Acta Radiol. 2013;54(4):369–73.CrossRefPubMed

10.

Ayala-Peacock DN, Thomas AJ, Smith H, Garg P, Blackstock AW. A Pilot 11C-choline PET-CT imaging study in patients with locally advanced esophageal cancer. Pract Radiat Oncol. 2013;3(2 Suppl 1):23.CrossRef

11.

Cremonesi M, Garibaldi C, Timmerman R, Ferrari M, Ronchi S, Grana CM, et al. Interim 18F-FDG-PET/CT during chemo-radiotherapy in the management of oesophageal cancer patients. Radiother Oncol. 2017;125(2):200–12.CrossRefPubMed

12.

Gang N, Chen X. Why integrin as a primary target for imaging and therapy. Theranostics. 2011;1(1):30–47.

13.

GAO Shi MA, Qingjie WEN, Qiang JIA, Bing LIU, Zhaofei CHEN, Zuowei, et al. ~(99 m)Tc-3P_4—RGD_2 radiotracers for SPECT/CT of esophageal tumor. Nucl Sci Tech. 2013;24(4):38–43.

14.

Jin X, Liang N, Wang M, Meng Y, Jia B, Shi X, et al. Integrin Imaging with 99 m Tc-3PRGD2 SPECT/CT shows high specificity in the diagnosis of lymph node metastasis from non-small cell lung cancer. Radiology. 2016;281(3):958–66.CrossRefPubMed

15.

Sobin LH, Gospodarowicz M. TNM classification of malignant tumours. John Wiley & Sons: New York, USA; 2009.

16.

Guanghui C, Shi G, Tiefeng J, Qingjie M, Bing j, Zhuowei C, et al. Pharmacokinetics and radiation dosimetry of, (99 m) Tc-3PRGD_2 in healthy individuals: A pilot study. Nucl Sci Tech. 2012;23(6):349–54.

17.

Korst RJ, Rusch VW, Venkatraman E, Bains MS, Burt ME, Downey RJ, et al. Proposed revision of the staging classification for esophageal cancer. J Thorac Cardiovasc Surg. 1998;115(3):660–9.CrossRefPubMed

18.

Lerut T, Coosemans W, Decker G, De Leyn P, Nafteux P, Van Raemdonck D. Cancer of the esophagus and gastro-esophageal junction: potentially curative therapies. Surg Oncol. 2001;10(3):113–22.CrossRefPubMed

19.

Stacker SA, Williams SP, Karnezis T, Shayan R, Fox SB, Achen MG. Lymphangiogenesis and lymphatic vessel remodelling in cancer. Nat Rev Cancer. 2014;14(3):159–72.CrossRefPubMed

20.

Ma Q, Ji B, Jia B, Gao S, Ji T, Wang X, et al. Differential diagnosis of solitary pulmonary nodules using 99mTc-3P4-RGD2 scintigraphy. Eur J Nucl Med Mol Imaging. 2011;38(12):2145–52.CrossRefPubMed

21.

Ma Q, Chen B, Gao S, Ji T, Wen Q, Song Y, et al. 99mTc-3P4-RGD2 scintimammography in the assessment of breast lesions: comparative study with 99mTc-MIBI. PLoS One. 2014;9(9):e108349.CrossRefPubMedPubMedCentral

22.

Liu L, Song Y, Gao S, Ji T, Zhang H, Ji B, et al. (99)mTc-3PRGD2 scintimammography in palpable and nonpalpable breast lesions. Mol Imaging. 2013;13(5):1–7.

23.

Zhu Z, Miao W, Li Q, Dai H, Ma Q, Wang F, et al. 99mTc-3PRGD2 for integrin receptor imaging of lung cancer: a multicenter study. J Nucl Med. 2012;53(5):716–22.CrossRefPubMed

24.

Ma Q, Min K, Wang T, Chen B, Wen Q, Wang F, et al. (99 m)Tc-3PRGD 2 SPECT/CT predicts the outcome of advanced nonsquamous non-small cell lung cancer receiving chemoradiotherapy plus bevacizumab. Ann Nucl Med. 2015;29(6):519–27.CrossRefPubMed

25.

Kato H, Kimura H, Nakajima M, Sakai M, Sano A, Tanaka N, et al. The additional value of integrated PET/CT over PET in initial lymph node staging of esophageal cancer. Oncol Rep. 2008;20(4):857–62.PubMed

26.

Kato H, Kuwano H, Nakajima M, Miyazaki T, Yoshikawa M, Ojima H, et al. Comparison between positron emission tomography and computed tomography in the use of the assessment of esophageal carcinoma. Cancer. 2002;94(4):921–8.CrossRef

27.

Horton MA. The alpha v beta 3 integrin “vitronectin receptor”. Int J Biochem Cell Biol. 1997;29(5):721–5.CrossRefPubMed

Title: Advantages of 99mTc-3PRGD2 SPECT over CT in the preoperative assessment of lymph node metastasis in patients with esophageal cancer
Authors: Ningning Lv
Shi Gao
Lin Bai
Bin Ji
Jinru Xue
Xiaoguang Ge
Bin Chen
Publication date: 01-01-2019
Publisher: Springer Singapore
Published in: Annals of Nuclear Medicine / Issue 1/2019
Print ISSN: 0914-7187
Electronic ISSN: 1864-6433
DOI: https://doi.org/10.1007/s12149-018-1300-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Advantages of ^99mTc-3PRGD₂ SPECT over CT in the preoperative assessment of lymph node metastasis in patients with esophageal cancer

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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