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Tc-99m depreotide SPECT/CT for lymph node staging of non-small-cell lung cancer

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Abstract

Objective

To investigate the potential role of Tc-99m depreotide (Tc-DEPR) in the preoperative lymph node (N) staging of non-small-cell lung cancer (NSCLC).

Methods

Sixty-one patients with NSCLC at the potentially operable stage were enrolled and underwent scintigraphy before surgery (n = 56) or mediastinoscopy (n = 5). Imaging was performed with a hybrid single photon emission computed tomography/computed tomography (SPECT/CT) system. Depreotide uptake in N stations was evaluated visually and semi-quantitatively and compared to histology. Quantification was carried out in attenuation-corrected SPECT slices. Different sites of normal uptake were used as a reference for comparison with lesional uptake. Receiver operating characteristic analysis was employed to identify the most preferable reference area and the cut-off best discriminating disease-free from disease-involved lymph nodes.

Results

With reference to 53 Ν1 hilar and 147 Ν2/Ν3 sampled stations, sensitivity of scintigraphy by visual interpretation was 100 and 94 %, specificity 43 and 59 % and accuracy 55 and 67 %, respectively. No patient was down-staged, but 52 % were incorrectly up-staged and 44 % were misclassified as inoperable. Compared to scintigraphy, preoperative contrast-enhanced diagnostic CT demonstrated lower sensitivity (36 % for hilar and 73 % for N2/N3 stations), higher specificity (79 and 75 %) and similar accuracy (70 and 75 %). Regarding the ultimate N-stage and the prediction of surgical disease, diagnostic CT was wrong in 51 and 34 % of cases. Dichotomy of quantitative scintigraphic data by the use of certain N-to-spine ratio cut-offs resulted in a significant increase of specificity (76 % for hilar and 89 % for N2/N3 stations), while sensitivity remained high (82 % in both circumstances) and accuracy for Ν2/Ν3 stations was substantially improved (88 %). By this quantitative approach, misclassifications as to the N-stage and patient operability (25 and 16 %) were considerably less than that of visual Tc-DEPR and diagnostic CT interpretations.

Conclusion

Tc-99m depreotide SPECT/CT seems to have a role in the N-staging of NSCLC, mainly because of its high sensitivity and negative predictive value. Quantification of uptake can improve specificity, at a low cost of sensitivity. If F-18 fluoro-deoxyglucose positron emission tomography is not available, this method may be used as a surrogate to conventional staging modalities.

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References

  1. O’Connor SJ. Review of the incidence, prevalence, mortality and causative factors for lung cancer in Europe. Eur J Cancer. 2011;47(suppl 3):S346–7.

    Article  PubMed  Google Scholar 

  2. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.

    Article  PubMed  Google Scholar 

  3. Berrino F, De Angelis R, Sant M, Rosso S, Bielska-Lasota M, Coebergh JW, et al. Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995–99: results of the EUROCARE-4 study. Lancet Oncol. 2007;8:773–83.

    Article  PubMed  Google Scholar 

  4. Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The IASLC lung cancer staging project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol. 2007;2:706–14.

    Article  PubMed  Google Scholar 

  5. Walker CM, Chung JH, Abbott GF, Little BP, El-Sherief AH, Shepard JA, et al. Mediastinal lymph node staging: from noninvasive to surgical. AJR Am J Roentgenol. 2012;199:W54–64.

    Article  PubMed  Google Scholar 

  6. Detterbeck FC, Jantz MA, Wallace M, Vansteenkiste J, Silvestri GA. Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132(3 suppl):202S–20S.

    Article  PubMed  Google Scholar 

  7. Silvestri GA, Gould MK, Margolis ML, Tanoue LT, McCrory D, Toloza E, et al. Noninvasive staging of non-small cell lung cancer: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest. 2007;132(3 suppl):178S–201S.

    Article  PubMed  Google Scholar 

  8. Gould MK, Kuschner WG, Rydzak CE, Maclean CC, Demas AN, Shigemitsu H, et al. Test performance of positron emission tomography and computed tomography for mediastinal staging in patients with non-small-cell lung cancer: a meta-analysis. Ann Intern Med. 2003;139:879–92.

    Article  PubMed  Google Scholar 

  9. Lardinois D, Weder W, Hany TF, Kamel EM, Korom S, Seifert B, et al. Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med. 2003;348:2500–7.

    Article  PubMed  Google Scholar 

  10. Chao F, Zhang H. PET/CT in the staging of the non-small-cell lung cancer. J Biomed Biotechnol. 2012;2012:783739. doi:10.1155/2012/783739.

    PubMed Central  PubMed  Google Scholar 

  11. Virgolini I, Leimer M, Handmaker H, Lastoria S, Bischof C, Muto P, et al. Somatostatin receptor subtype specificity and in vivo binding of a novel tumor tracer, 99mTc-P829. Cancer Res. 1998;58:1850–9.

    CAS  PubMed  Google Scholar 

  12. Rodrigues M, Li S, Gabriel M, Heute D, Greifeneder M, Virgolini I. 99mTc-depreotide scintigraphy versus 18F-FDG-PET in the diagnosis of radioiodine-negative thyroid cancer. J Clin Endocrinol Metab. 2006;91:3997–4000.

    Article  CAS  PubMed  Google Scholar 

  13. Apostolopoulos DJ, Papandrianos NI, Symeonidis A, Spyridonidis T, Alexiou S, Zampakis P, et al. Technetium-99m depreotide imaging by single photon emission tomography/low resolution computed tomography in malignant lymphomas: comparison with gallium-67 citrate. Ann Nucl Med. 2010;24:639–47.

    Article  CAS  PubMed  Google Scholar 

  14. Herlin G, Lundell L, Ost A, Aspelin P, Svensson L, Axelsson R. Quantitative assessment of (99m)Tc-depreotide uptake in oesophageal cancer and precursor conditions and its reflection in immunohistochemically detected somatostatin receptors. Radiol Res Pract. 2012;2012:415616. doi:10.1155/2012/415616.

    PubMed Central  PubMed  Google Scholar 

  15. Herlin G, Kölbeck KG, Menzel PL, Svensson L, Aspelin P, Capitanio A, et al. Quantitative assessment of 99mTc-depreotide uptake in patients with non-small-cell lung cancer: immunohistochemical correlations. Acta Radiol. 2009;50:902–8.

    Article  CAS  PubMed  Google Scholar 

  16. Blum J, Handmaker H, Lister-James J, Rinne N. A multicenter trial with a somatostatin analog 99m-Tc depreotide in the evaluation of solitary pulmonary nodules. Chest. 2000;117:1232–8.

    Article  CAS  PubMed  Google Scholar 

  17. Shih WJ, Samayoa L. Tc-99m depreotide detecting malignant pulmonary nodules. Histopathologic correlation with semiquantitative tumour-to-normal lung ratio. Clin Nucl Med. 2004;29:171–6.

    Article  PubMed  Google Scholar 

  18. Naalsund A, Maublant J. The solitary pulmonary nodule—is it malignant or benign? Diagnostic performance of Tc-depreotide SPECT. Respiration. 2006;73:634–41.

    Article  PubMed  Google Scholar 

  19. Papotti M, Croce S, Bellò M, Bongiovanni M, Allìa E, Schindler M, et al. Expression of somatostatin receptor types 2, 3 and 5 in biopsies and surgical specimens of human lung tumours. Correlation with preoperative octreotide scintigraphy. Virchows Arch. 2001;439:787–97.

    Article  CAS  PubMed  Google Scholar 

  20. Reubi JC, Schaer JC, Laissue JA, Waser B. Somatostatin receptors and their subtypes in human tumors and in peritumoral vessels. Metabolism. 1996;45(8 suppl 1):39–41.

    Article  CAS  PubMed  Google Scholar 

  21. Kahn D, Menda Y, Kernstine K, Bushnell D, McLaughlin K, Miller S, et al. 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. Chest. 2004;125:494–501.

    Article  CAS  PubMed  Google Scholar 

  22. Danielsson R, Bååth M, Svensson L, Forslöv U, Kölbeck KG. Imaging of regional lymph node metastases with 99mTc-depreotide in patients with lung cancer. Eur J Nucl Med Mol Imaging. 2005;32:925–31.

    Article  PubMed  Google Scholar 

  23. Karathanos E, Datseris I, Vlontzou E, Zisimopoulos A, Georgiou E. Contribution of (99m)Tc-depreotide (Neospect) scintigraphy in lung cancer staging. J BUON. 2010;15:147–52.

    CAS  PubMed  Google Scholar 

  24. Mountain CF, Dresler CM. Regional lymph node classification for lung cancer staging. Chest. 1997;111:1718–23.

    Article  CAS  PubMed  Google Scholar 

  25. De Leyn P, Lardinois D, Van Schil PE, Rami-Porta R, Passlick B, Zielinski M, et al. ESTS guidelines for preoperative lymph node staging for non-small cell lung cancer. Eur J Cardiothorac Surg. 2007;32:1–8.

    Article  PubMed  Google Scholar 

  26. Wu LM, Xu JR, Gu HY, Hua J, Chen J, Zhang W, et al. Preoperative mediastinal and hilar nodal staging with diffusion-weighted magnetic resonance imaging and fluorodeoxyglucose positron emission tomography/computed tomography in patients with non-small-cell lung cancer: which is better? J Surg Res. 2012;178:304–14.

    Article  PubMed  Google Scholar 

  27. Menda Y, Kahn D. Somatostatin receptor imaging of non-small cell lung cancer with 99mTc depreotide. Semin Nucl Med. 2002;32:92–6.

    Article  PubMed  Google Scholar 

  28. van Hagen PM, Krenning EP, Kwekkeboom DJ, Reubi JC, Anker-Lugtenburg PJ, Löwenberg B, et al. Somatostatin and the immune and haematopoetic system; a review. Eur J Clin Invest. 1994;24:91–9.

    Article  PubMed  Google Scholar 

  29. Dimitrakopoulou-Strauss A, Georgoulias V, Eisenhut M, Herth F, Koukouraki S, Mäcke HR, et al. Quantitative assessment of SSTR2 expression in patients with non-small cell lung cancer using (68)Ga-DOTATOC PET and comparison with (18)F-FDG PET. Eur J Nucl Med Mol Imaging. 2006;33:823–30.

    Article  PubMed  Google Scholar 

  30. Traub-Weidinger T, Von Guggenberg E, Dobrozemsky G, Kendler D, Eisterer W, Bale R, et al. Preliminary experience with (68)Ga-DOTA-lanreotide positron emission tomography. Q J Nucl Med Mol Imaging. 2010;54:52–60.

    CAS  PubMed  Google Scholar 

  31. Sobic-Saranovic DP, Pavlovic SV, Artiko VM, Saranovic DZ, Jaksic ED, Subotic D, et al. The utility of two somatostatin analog radiopharmaceuticals in assessment of radiologically indeterminate pulmonary lesions. Clin Nucl Med. 2012;37:14–20.

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University General Hospital of Patras, Medical School, University of Patras, Rion, 26500, Patras, Greece

    Dimitris J. Apostolopoulos, Trifon Spyridonidis, Anna Paschali, Nikolaos Papandrianos & Pavlos J. Vassilakos

  2. Department of Cardiothoracic Surgery, University General Hospital of Patras, Medical School, University of Patras, Patras, Greece

    Efstratios N. Koletsis, Eleni Stamou & Dimitrios Dougenis

Authors
  1. Dimitris J. Apostolopoulos
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  2. Efstratios N. Koletsis
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  3. Trifon Spyridonidis
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  5. Nikolaos Papandrianos
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  6. Eleni Stamou
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  7. Pavlos J. Vassilakos
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  8. Dimitrios Dougenis
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Correspondence to Dimitris J. Apostolopoulos.

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Apostolopoulos, D.J., Koletsis, E.N., Spyridonidis, T. et al. Tc-99m depreotide SPECT/CT for lymph node staging of non-small-cell lung cancer. Ann Nucl Med 28, 463–471 (2014). https://doi.org/10.1007/s12149-014-0839-4

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  • DOI: https://doi.org/10.1007/s12149-014-0839-4

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