Unit:
Τομέας Βασικών ΕπιστημώνLibrary of the School of Health Sciences
Dissertation committee:
Ιουλία Μαλαμίτση Αναπληρώτρια Καθηγήτρια Ιατρικής Φυσικής, Λάμπρος Βλάχος Καθηγητής Ακτινολογίας Αθανάσιος Γουλιάμος Καθηγητής Ακτινολογίας
Original Title:
Τc-99m depreotide : διάγνωση, σταδιοποίηση και παρακολούθηση ασθενών με καρκίνο πνεύμονος.
Summary:
99mTc-depreotide is a small synthetic decapeptide labelled somatostatin
analogue, which has the ability to bind selectively to 2, 3 and 5 subtypes of
somatostatin receptors (SSTRs). SSTRs are upregulated in malignant tumors
including small cell, and non-small cell lung cancer. The aim of the present
thesis was to assess the clinical value of somatostatin receptor scintigraphy
with 99mTc-depreotide in patients with lung cancer a) preoperative for
diagnosis and staging b) post-therapeutic of any disease relapse. We studied
123 patients, 101 men and 22 women of median age 63.2 years (range 38 - 90
years) who were classified into 2 groups. In the first group, 79 patients
tested preoperatively for diagnosis and staging of disease and in the second
group 44 patients with known primary lung cancer after initial treatment were
assessed for disease recurrence. All patients underwent 99mTc-depreotide
whole-body scan and SPECT imaging of the thorax. Fifty seven out of 79 patients
from the first group, had histological findings consistent with malignancy
(72.2%) and 22 (27.8%) revealed benign pulmonary lesions. Fifty-five of 57
(96.5%) were correctly identified as positive and 16/22 (72.7%) as negative
with 99mTc-depreotide scintigraphy. The positive predictive value, negative
predictive value and overall diagnostic accuracy of 99mTc-depreotide were
90.1%, 88.9% and 89.9% respectively. The pathological investigation of 48
patients with primary lung cancer after mediastinoscopy or thoracotomy revealed
metastases in mediastinal lymph nodes in 23 patients whereas 25 were free of
disease. When 99mTc-depreotide stage was compared with histopathologic stage,
the disease in 21 (91.3%) patients was accurately staged. Τhere was a
statistically significant difference in the diagnostic accuracy for
99mTc-depreotide SPECT imaging in staging of lung cancer 91.6% versus chest CT
66.7% (p<0,05). Preoperative staging with 99mTc-depreotide whole body imaging
revealed unexpected distant metastases in six (12.5%) patients (4 patients with
bone and 2 with brain metastases). Twenty - six of 44 patients (50.1%) of the
second group, had confirmed disease recurrence and 18 (40.9%) had no evidence
of disease. 99mTc-depreotide correctly diagnosed recurrence in all 26/26
patients (100%) and provided true negative findings in 15/18 (83.3%) who had no
evidence of recurrence. The positive predictive value, negative predictive
value and diagnostic accuracy of 99mTc-depreotide in the prediction of lung
cancer relapse were 89,6%, 100% and 93,2%, respectively.
In conclusion, the results of the present study suggest that 99mTc-depreotide
has a diagnostic ability in distinguishing malignant from benign lung lesions,
in the initial staging of non-small cell lung cancer, enables early detection
of intrathoracic or extrathoracic metastases and after initial treatment shows
high capability to detect residual or recurrent disease.
Keywords:
Lung cancer, Somatostatin receptors, Radiolabelled peptides
Number of references:
443
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