Tài liệu Value of PET/CT in diagnosis of lung cancer – Bui Anh Thang: Journal of military pharmaco-medicine n
o
8-2018
170
VALUE OF PET/CT IN DIAGNOSIS OF LUNG CANCER
Bui Anh Thang1; Pham Ngoc Hoa1; Do Quyet2
SUMMARY
Objectives: To remark on SUV of PET/CT in small-cell and non-small cell lung cancer and
determine the value of PET/CT in the diagnosis of lung cancer. Subjects and methods:
58 patients diagnosed with lung cancer on PET/CT (24 patients with small cell and 34 patients
with non-small cell in Oncology and Nuclear Medicine Center of Bachmai Hospital, from August
2010 to October 2015. Patients were performed with PET/CT to diagnose with lung cancer
(size, metastasis) and compared with histopathological results. Results: 24 patients were
diagnosed with small cell lung cancer, 33 patients were diagnosed with non-small cell lung
cancer and 1 patient with benign lesion. The average of SUV was 5.91 ± 2.12. The average
SUV was higher significantly in group of non-small cell than small cell lung cancer (6.58 ± 2.35 vs.
5.01...
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Journal of military pharmaco-medicine n
o
8-2018
170
VALUE OF PET/CT IN DIAGNOSIS OF LUNG CANCER
Bui Anh Thang1; Pham Ngoc Hoa1; Do Quyet2
SUMMARY
Objectives: To remark on SUV of PET/CT in small-cell and non-small cell lung cancer and
determine the value of PET/CT in the diagnosis of lung cancer. Subjects and methods:
58 patients diagnosed with lung cancer on PET/CT (24 patients with small cell and 34 patients
with non-small cell in Oncology and Nuclear Medicine Center of Bachmai Hospital, from August
2010 to October 2015. Patients were performed with PET/CT to diagnose with lung cancer
(size, metastasis) and compared with histopathological results. Results: 24 patients were
diagnosed with small cell lung cancer, 33 patients were diagnosed with non-small cell lung
cancer and 1 patient with benign lesion. The average of SUV was 5.91 ± 2.12. The average
SUV was higher significantly in group of non-small cell than small cell lung cancer (6.58 ± 2.35 vs.
5.01 ± 1.35; p < 0.01). PET/CT diagnosis of lung cancer had the accuracy of 98.3%. Conclusion:
PET/CT diagnosis of lung cancer has a very high accuracy.
* Keywords: Lung cancer; Non-small cell lung cancer; PET/CT; Value.
INTRODUCTION
Lung cancer is the most common
cause of cancer death in Europe in 2006
(about 334,800 deaths) and is the second
frequent type of cancer after prostate
cancer in men. The morbidity and
mortality rate in 2006 was 75.3 and 64.8
per 100,000 people per year, respectively
[2]. In Vietnam, according to the cancer
epidemiology record in 2004, lung cancer
was the leading one among men with the
incidence in Hanoi of 39.8/100,000 [1].
Late detection of lung cancer can
result in poor prognosis, high mortality
and death in a short time. Early diagnosis
and evaluation of lung cancer is essential
and urgent. So we made this study with a
view to:
Examining SUV value of small and
non-small cell lung cancer and determining
the value of PET/CT in the diagnosis of
lung cancer.
SUBJECTS AND METHODS
1. Subjects.
58 patients diagnosed with lung cancer
on PET/CT in Nuclear Medicine and Cancer
Center, Bachmai Hospital, with histopathological
examination.
Study time: from August 2010 to October
2015.
2. Methods.
- Design study description:
+ SUV value of small and non-small
cell lung cancer.
1. Pham Ngoc Thach Medical University
2. Vietnam Military Medical University
Corresponding author: Bui Anh Thang (anhthangcdha@gmail.com)
Date received: 17/08/2018
Date accepted: 26/09/2018
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+ Determine the value of PET/CT for
definite diagnosis and metastatic detection
in lung cancer.
- The study variables included age,
gender, PET/CT variables (including SUV,
tumor size, metastatic location, diagnosis
of lung cancer), pathology (lung cancer)
small cells, non-small cell lung cancer,
inflammatory lesions.
- Process of survey PET/CT:
+ Video recorder PET/CT: PET/CT
Biograph True Point - Siemens (Germany).
+ Prepare the patient:
Patients abstain from food at least
4 hours before PET/CT.
Patients were examined, exploited a
history of illness, records for each patient,
measurement of weight, height, pulse,
blood pressure, temperature.
Check the blood glucose before injection
18F-FDG (blood sugar must be less than
8.0 nmoL/L).
- Place a fixed intravenous line.
After 18F-FDG injection, the patient
stayed at the monitoring room, limiting
movement and speech before shooting.
Patients should urinate before shooting.
18F-FDG: 18F-FDG (2-fluoro-2-deoxy-D-
glucose solution). Dosage: 0.15 - 0.20 mCi/kg
body weight (7 - 12 mCi) intravenously.
PET/CT: Performed after 18F- FDG 45 -
60 min. Capture whole body from skull base
to 1/3 on femur. Capture additional areas.
+ Image processing and results recognition:
The results were analyzed after PET
imaging, CT imaging, PET/CT integration
and absorption and distribution of 18F-FDG.
Qualitative indices such as size,
volume of injury, density, SUV were also
measured for each of the losses to
combine the results of the final evaluation.
SUV = [mCi/mL (calibrated decomposition)
of tissue organization]/[injection dose
(mCi)/gram weight).
The SUV value of the lesion found was
compared to the median blood vessel
volume in the mediastinum (average
SUV = 2.5). With SUV values of 2 - 2.5,
suspicion of benign and malignant lesions.
SUV values > the activity of blood vessels
in the mediastinum (2.5) can identify
malignant lesions.
- Comparisons of PET/CT results with
histopathological findings: PET/CT (+):
PET/CT images diagnosed with lung
cancer. PET/CT (-): The PET/CT image is
not diagnosed with lung cancer.
Pathological anatomy results (+): surgery for
lung cancer. Pathological anatomy results
(-): anxiety is a benign lesion.
- Data processing: According to the
software SPSS 22.0.
RESULTS
1. Age and gender.
Table 1: Age and gender.
Features
Small cell
lung cancer
(n = 24)
Non-small cell
lung cancer
(n = 33)
Total
(n = 57)
Minimum age 44 34 34
Maximum age 81 74 81
Mean age 61.1 ± 8.6 59.7 ± 8.2 60.3 ± 8.3
Sex (male) 22 (91.7%) 24 (72.7%) 46 (80.7%)
Mean age of lung cancer patients was
60.3 ± 8.3; no difference between small and
non-small cell groups, minimum age 34,
the oldest 81. Mostly were male patients
(80.7%).
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2. Histologic diagnosis.
Table 2: Classification of lung cancer based on histopathological findings.
Classification Patients (n) Rate (%)
Small cell lung cancer 24 42.1
Squamous cell carcinoma 6 10.5 Non-small cell lung cancer
Adenocarcinoma 27 47.4
Total 57 100
Of 57 lung cancer patients, 24 cases suffered from small cell lung cancer, 33 patients
had non-small cell lung cancer (of which squamous cell carcinoma and
adenocarcinoma accounted for 10.5%; 47.4%, respectively).
3. Metastatic rate.
Table 3:
Classification Patients Patients with metastasis (n) Metastatic rate (%)
Small cell lung cancer 24 21 87.5
Non-small cell lung cancer 33 28 84.8
Total 57 49 86.0
The prevalence of lung cancer was 86.0%; of which 87.5% for small cell spam and
84.8% for non-cell cancers.
4. The SUV of the primary tumor.
Table 4:
SUV
Small cell lung cancer
(n = 24)
Non-small cell lung cancer
(n = 33)
Total (n = 57)
Minimum 2.82 3.07 2.82
Maximum 8.38 13.39 13.39
Mean 5.01 ± 1.35 6.58 ± 2.35 (**) 5.91 ± 2.12
(**: p < 0.01)
The mean SUV compatible with the SUV was 5.91 ± 2.12, with SUVs in the non-small
cell lung group significantly higher than in the small cell population (6.58 ± 2.35 vs.
5.01 ± 1.35, p < 0.01).
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5. Value of PET/CT in the diagnosis of lung cancer.
Table 5: Comparing the PET/CT findings with the histopathology result.
Histopathology (+) Histopathology (-) Total
PET/CT (+) 57 1 58
PET/CT (-) 0 0 0
Total 57 1 58
The rate of PET/CT diagnosed with lung cancer was 57/58, accounting for 98.3%.
DISCUSSION
In the world, lung cancer is the most
common cause of cancer death among
men and women [3]. Non-small cell lung
cancer and small cell lung cancer (based
on histopathological classification) account
for about 85% and 15%, respectively [4].
Patients with small cell lung cancer are
mostly males (80.7%), mean age 60. The
results of our study are consistent with
Park M.R et al’s findings: The average
age of patients was 65.66 years and
85.5% were males [5].
In the 57 patients with lung cancer,
there were 24 cases of small cell lung
cancer, 33 non-small cell lung cancer (of
which 10.5% were squamous cell carcinoma,
adenocarcinoma carcinoma occupied 47.4%).
According to our results, the metastatic
rate in lung cancer was 86.0%. In particular,
small cell lung cancer had a metastatic rate
of 87.5% and 84.8% for non-small cell
lung cancer. Thus, although the tumor was
small in size, this type of cancer often precedes
metastatic non-small cell lung cancer.
SUV value for moderate lung cancer:
5.91 ± 2.12, in which SUV values in non-
small cell groups were significantly greater
than small cell groups (6.58 ± 2.35 vs.
5.01 ± 1.35; p < 0.01).
PET/CT is very valuable in assessing
lung cancer. In addition, PET/CT helps to
diagnose and differentiate primary cancer
and lung metastatic lesions: ∆SUV was
significantly higher in patients with
primary cancer than in lung metastases
[6]. The SUV's value assortment helps to
distinguish benign tumors and benign
lesions in the lung, thereby providing a
basis for the development of appropriate
treatment regimens.
PET/CT is a very good imaging technique,
with a higher sensitivity, specificity and
accuracy than CT and MRI alone in the
diagnosis of lung cancer and assessment
of lung cancer stage [2]. Our study showed
that the rate of PET/CT diagnosed with
lung cancer was 57/58, compared with
57/58 cases, accounting for a very high
proportion (98.3%).
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Figure 1: Primary tumors (non-small cell lung cancer).
Figure 2: Primary tumors (small cell lung cancer).
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Figure 3: Bone metastasis from small cell lung cancer.
Figure 4: Lymph node in small cell lung cancer.
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Figure 5: Lymph node in non-small cell lung cancer.
CONCLUSION
SUV for moderate lung cancer was
5.91 ± 2.12, with SUVs in the non-small
cell lung cancer group were significantly
higher than in the small cell group (6.58 ±
2.35 and 5.01 ± 1.35).
PET/CT diagnosed with lung cancer
was an accuracy of 98.3% compared to
the histopathologic result.
REFERENCE
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Việt Nam giai đoạn 2001 - 2004. Tạp chớ Y
học Thực hành. 2006, tr.9-17.
2. Sứrensen M, Pijls-Johannesma M, Felip
E; ESMO Guidelines Working Group. Small-
cell lung cancer: ESMO clinical practice
guidelines for diagnosis, treatment and follow-
up. Ann Oncol. 2010, 21 Suppl 5, pp.120-125.
3. Jemal A, Siegel R, Xu J, Ward E.
Cancer statistics. CA Cancer J Clin. 2010, 60,
pp.277-300.
4. Brambilla E, Travis W.D, Colby T.V,
Corrin B, Shimosato Y. The new World Health
Organization classification of lung tumours.
Eur Respir J. 2001, 18, pp.1059-1068.
5. Park M.R, Park Y.H, Choi J.W.
Progression-free survival: An important
prognostic marker for long-term survival of
small cell lung cancer. Tuberc Respir Dis
(Seoul). 2014, 76 (5), pp.218-225.
6. Dijkman B.G, Schuurbiers OCJ. The role
of 18F-FDG PET in the differentiation
between lung metastases and synchronous
second primary lung tumours. Eur J Nucl Med
Mol Imaging. 2010, 37 (11), pp.2037-2047.
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