technetium-tc-99m-tetrofosmin and Carcinoma--Non-Small-Cell-Lung

In patients with non-small cell lung cancer (NSCLC), surgical resection offers the best chance of cure. The preoperative assessment of mediastinal lymph node involvement is crucial to selecting those patients for whom surgery is indicated.. To evaluate the possible clinical role of (99m)Tc-tetrofosmin scintigraphy in the presurgical detection of mediastinal node metastases from NSCLC, we performed a prospective comparative study with CT on 83 patients (48 men, 35 women; age range, 38-81 y) with primary NSCLC (36 adenocarcinomas, 39 epidermoid squamous cell carcinomas, and 8 large cell anaplastic carcinomas). They underwent chest SPECT 20 min after (99m)Tc-tetrofosmin injection (740 MBq intravenously). The metastatic involvement of mediastinal nodes was assessed by histologic examination after mediastinoscopy or thoracotomy. Both chest CT and (99m)Tc-tetrofosmin scintigraphy were performed within 2 wk before the surgical staging.. Metastatic mediastinal lymph nodes were found in 35 patients. (99m)Tc-Tetrofosmin imaging in assessing the mediastinal involvement yielded a sensitivity of 85.7%, a specificity of 89.6%, and an accuracy of 88.0%; CT results were 68.6%, 75.0%, and 72.3%, respectively. SPECT accuracy was significantly higher than CT accuracy (P < 0.05). However, precise anatomic localization of (99m)Tc-tetrofosmin uptake in the mediastinum was not always present on SPECT images. (99m)Tc-Tetrofosmin SPECT precisely detected the presence or absence of lymph node metastases in 33 of the 36 patients with positive CT findings (enlarged mediastinal nodes with a short axis > or =1 cm), with an accuracy (91.7%) significantly higher (P < 0.05) than that of CT (66.7%).. (99m)Tc-Tetrofosmin SPECT is a useful presurgical noninvasive method to assess mediastinal lymph node involvement in NSCLC. In particular, it could play a clinical role in reducing the number of invasive staging surgical procedures in selected patients, especially in those with enlarged lymph nodes at CT. Fusing SPECT with CT images could further improve the interpretation of the scintigraphic data.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Female; Humans; Lung Neoplasms; Lymphatic Metastasis; Male; Mediastinal Neoplasms; Middle Aged; Neoplasm Staging; Organophosphorus Compounds; Organotechnetium Compounds; Preoperative Care; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Technetium-99m-tetrofosmin is a radiopharmaceutical employed for myocardial imaging, which has recently emerged as useful in the visualization of tumors. In this study technetium-99m-tetrofosmin was evaluated for its accuracy in differentiating malignant from benign pulmonary lesions, and in detecting mediastinal node metastasis due to lung cancer. Eighty-one patients with a solitary lung lesion on the chest radiograph and/or CT scan were submitted to chest single photon emission computed tomography after technetium-99m-tetrofosmin injection (740 MBq i.v.). The scintigraphic findings were correlated to the final histopathological diagnosis, demonstrating abnormal tracer accumulation in 51 of 54 malignant lesions (sensitivity 94%) and in 4 out of 27 benign conditions (specificity 85%), yielding an accuracy of 91%. Mediastinal lymph-node involvement was evaluated in 35 patients with non small cell lung cancer who underwent mediastinoscopy and/or surgery. Tetrofosmin accuracy (89%) was significantly higher than that of CT (69%, p < 0.05); the false negative scintigraphic results were in nodes sized less than 1 cm. In conclusion, technetium-99m-tetrofosmin imaging is useful in distinguishing malignant from benign pulmonary lesions, and in non-invasively assessing mediastinal node metastases from non small cell lung cancer, especially in patients with enlarged nodes by CT scan.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Diagnosis, Differential; False Negative Reactions; False Positive Reactions; Female; Humans; Lung Diseases; Lung Neoplasms; Lymphatic Metastasis; Male; Mediastinal Neoplasms; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Predictive Value of Tests; Radiopharmaceuticals; Sensitivity and Specificity; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

99mTc-tetrofosmin single photon emission computed tomography (SPECT) is routinely used in the evaluation of coronary artery disease. A variety of different tumors, however, also demonstrate 99mTc-tetrofosmin uptake. We report six patients found with unexpected mediastinal and thoracic tumor uptake during Tc-tetrofosmin myocardial perfusion scintigraphy (MPS).. We investigated 2,155 patients with Tc-tetrofosmin MPS during 2006-2007. One thousand four hundred and eighty-six of these patients had no coronary history and were sent to our department due to newly developed thoracic complaint such as chest pain, dyspnea and others. Six hundred and sixty-nine patients had coronary history. All patients underwent 99mTc-tetrofosmin exercise study. Patients with unexpected extracardiac Tc-tetrofosmin findings during MPS were referred to PET/CT for further diagnostic investigation. Region of interest (ROI; 99mTc-tetrofosmin) and SUVmax (2-[F]fluoro-2-deoxy-D-glucose, F-FDG) were estimated and the results were compared with histological findings.. Abnormal mediastinal and/or thoracic activities were visualized in six of the 2,155 patients with 99mTc-tetrofosmin images. Subsequently, the patients underwent resection of a thymoma (n=2), nonsmall cell lung cancer (n=1) and breast cancer (n=3). In the patients with breast cancer one was a male patient with ductal, invasive breast cancer. Benign thymomas showed high 99mTc-tetrofosmin ROI >4.0 and low F-FDG SUVmax <2.0, whereas low 99mTc-tetrofosmin ROI <2.0 were found in nonsmall cell lung cancer and breast cancer and high F-FDG SUVmax >2.5 in these malignant tumors.. During Tc-tetrofosmin SPECT exercise stress tests performed in patients with suspected coronary artery disease, much more attention must be given to unexpected extracardiac uptakes. With 99mTc-tetrofosmin a large variety of different unknown tumors can be detected during MPS.

Topics: Aged; Breast Neoplasms, Male; Carcinoma, Non-Small-Cell Lung; Coronary Artery Disease; Female; Fluorodeoxyglucose F18; Heart; Humans; Lung Neoplasms; Male; Middle Aged; Myocardial Perfusion Imaging; Organophosphorus Compounds; Organotechnetium Compounds; Positron-Emission Tomography; Radiography; Radiopharmaceuticals; Thymoma; Thymus Neoplasms; Tomography, Emission-Computed; Tomography, Emission-Computed, Single-Photon

To evaluate the usefulness of 99mTc-tetrofosmin (TF) SPECT in the detection of intrathoracic malignant lesions, we studied 304 patients, 261 with malignant and 43 with benign lesions; 196 of the former had non-treated primary tumors, 193 lung cancer (LC) and 3 mesotheliomas, 11 had LC recurrences and 54 had metastases from different kinds of tumors. Twenty-nine patients with primary tumors were re-checked after chemotherapy or surgery. In all patients, after 740 MBq TF injection, both planar and SPECT images were acquired and analysed qualitatively, SPECT images also semiquantitatively. Scintigraphy was always compared to CT. SPECT showed higher sensitivity, specificity and accuracy values than CT (98.1, 90.7 and 97 vs. 96.2, 81.4, and 93.9%, respectively), their combined use achieving 100% sensitivity and 98.8% accuracy. Planar did not give more information than SPECT, showing a significantly lower sensitivity (63.2%) and accuracy (67.4%). SPECT showed higher accuracy values than CT and planar (86.9 vs. 78.3 and 69.6%) in NSCLC mediastinal lymph node staging. Moreover, SPECT was concordant with CT in correctly evaluating the response to chemotherapy or surgery in all monitorized primary tumors cases, except in one in whom only SPECT detected residual tumor. The semiquantitative analysis added useful information in differentiating malignant from benign lesions and in monitoring the response to chemo-therapy. TF SPECT appears a highly accurate diagnostic method in the detection of intrathoracic malignant lesions, in lungs and pleura, as well as in NSCLC mediastinal lymph node staging and in monitoring treatment effectiveness, playing a complementary role to CT in selected cases.

Topics: Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Combined Modality Therapy; False Negative Reactions; False Positive Reactions; Female; Humans; Lung Diseases; Lung Neoplasms; Lymphatic Metastasis; Male; Mesothelioma; Middle Aged; Neoplasm Recurrence, Local; Neoplasm, Residual; Organophosphorus Compounds; Organotechnetium Compounds; Pleural Neoplasms; Predictive Value of Tests; Radiopharmaceuticals; Sensitivity and Specificity; Thoracic Neoplasms; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Treatment Outcome

In vitro studies have shown that technetium-99m tetrofosmin (Tc-99m TF) is a transport substrate for the P-glycoprotein (Pgp) pump. Therefore, Tc-99m TF uptake of tumors can be used to predict chemotherapy response in lung cancers. However, whether lung resistance-related protein (LRP) expression affects tumor accumulation and efflux of Tc-99m TF in lung cancers is not known. Our aim was to use Tc-99m TF uptake of tumors to predict paclitaxel-based chemotherapy response of non-small cell lung cancer (NSCLC) and to compare Pgp or LRP expression. Twenty patients with advanced NSCLC received Tc-99m TF chest images before Taxol-based chemotherapy was used in this study. The chemotherapy response was evaluated by clinical and radiological methods in the third month after completion of treatment. No significant differences of prognostic factors (age, sex, body weight loss, performance status, tumor size, tumor stage, and tumor cell type) were found between the patients with good and those with poor responses. Early and delayed tumor/normal lung (T/L) uptake ratios were calculated on Tc-99m TF chest images. Immunohistochemical analyses were performed on multiple nonconsecutive sections of the biopsy specimens to detect Pgp and LPR expressions. The early and delayed T/L uptake ratios of 10 patients with good response were significantly higher than those of the other 10 patients with poor response. Significantly higher early and delayed T/L uptake ratios were found in patients with negative than those with positive Pgp expression ( p < 0.05). However, no significant differences of early and delayed T/L uptake ratios were found between patients with negative and positive LRP expressions ( p > 0.05). We found that Tc-99m TF imaging could accurately predict Taxol-base chemotherapy response. In addition, the Tc-99m TF tumor uptake was related to Pgp but not LPR expression in NSCLC.

Topics: Adult; Aged; Antineoplastic Agents, Phytogenic; ATP Binding Cassette Transporter, Subfamily B, Member 1; Carcinoma, Non-Small-Cell Lung; Cisplatin; Drug Resistance, Multiple; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Proteins; Organophosphorus Compounds; Organotechnetium Compounds; Paclitaxel; Radionuclide Imaging; Radiopharmaceuticals; Vault Ribonucleoprotein Particles

Technetium-99m tetrofosmin has been used as a tumor-imaging agent in cases of lung cancer. The authors present a case showing a lung tumor that concentrated Tl-201 distinctly more than Tc-99m tetrofosmin during a dual-isotope cardiac examination. A brief review of the literature is provided and possible explanations for this difference in tracer uptake are discussed.

Topics: Adenocarcinoma, Bronchiolo-Alveolar; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Male; Organophosphorus Compounds; Organotechnetium Compounds; Radionuclide Imaging; Radiopharmaceuticals; Thallium

One hundred fifteen patients with 119 pulmonary lesions in which malignancy was suspected underwent a SPECT study with 99mTc-Tetrofosmin (TTF) to assess the possible factors involved in the uptake of the radiopharmaceutical. The TTF uptake rate in the lung tumor with respect to that of healthy tissue (TTF index) was evaluated in terms of: benignity and malignancy, histological type, stage, cell differentiation, size, necrosis, survival and the influence of P-glycoprotein (Pgp), detected by immunohistochemistry, on the TTF uptake. The mean TTF index in the 18 benign lesions studied was 1.01 0.05, while that of the 101 malignant lesions was 1.59 0.45 (p < 0.001), with a positive predictive value of 97.7% and a negative predictive value of 50%. The comparison of the histological types, degree of cell differentiation, necrosis and stage revealed no statistically significant differences. With respect to size, those tumors measuring > 3 cm showed greater uptake than smaller lesions. In patients with non-small cell lung cancer, a positive relationship was observed between the TTF index and survival, a circumstance that did not occur in patients with small cell lung cancer. In the cases in which the presence of Pgp was assessed, there was an inverse relationship between the TTF ratio and Pgp expression. In conclusion, thoracic SPECT with 99mTc-TTF has a high positive predictive value for the presence of lung cancer, although a negative study does not rule out the existence of the disease. The reason for this is the inverse relationship between 99mTc-TTF uptake and the density of Pgp expression.

Topics: Adenocarcinoma; Adolescent; Adult; Aged; Aged, 80 and over; ATP Binding Cassette Transporter, Subfamily B, Member 1; Carcinoma, Non-Small-Cell Lung; Carcinoma, Small Cell; Cell Differentiation; Colorectal Neoplasms; Female; Histiocytoma, Benign Fibrous; Humans; Lung; Lung Diseases; Lung Neoplasms; Male; Middle Aged; Neoplasm Proteins; Organophosphorus Compounds; Organotechnetium Compounds; Prognosis; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

The staging of non-small-cell lung cancer (NSCLC) to detect mediastinal lymph node (MLN) metastases is very important for determining the therapeutic strategy.. Thirty-four patients with proven NSCLC were enrolled in this study. All patients underwent chest computed tomography (CT) and technetium-99m (Tc-99m) tetrofosmin chest single photon emission computed tomography (SPECT) preoperative staging. Mediastinal lymph node metastases were determined on the basis of postoperative pathologic findings to compare the diagnostic accuracy of chest CT with that of Tc-99m tetrofosmin chest SPECT.. Tc-99m tetrofosmin chest SPECT showed a diagnostic accuracy rate of 85.3% in detecting MLN metastases. Chest CT had an accuracy rate of 73.5%. If either Tc-99m tetrofosmin chest SPECT or chest CT with positive findings was considered as positive findings, the sensitivity was 94.7%. If either Tc-99m tetrofosmin chest SPECT or chest CT with negative findings was considered as negative, the specificity was 93.3%.. Tc-99m tetrofosmin chest SPECT was more accurate than chest CT in detecting MLN metastases in NSCLC patients. In addition, the combined use of Tc-99m tetrofosmin chest SPECT and chest CT could significantly increase the sensitivity and specificity compared with the single use of either Tc-99m tetrofosmin chest SPECT or chest CT.

Topics: Adult; Aged; Carcinoma, Non-Small-Cell Lung; Diagnosis, Differential; Female; Humans; Lung Neoplasms; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Reproducibility of Results; Sensitivity and Specificity; Thorax; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

The purpose of this study was to retrospectively predict the chemotherapeutic response to paclitaxel for non-small cell lung cancer (NSCLC) using 99mTc-tetrofosmin (TF) uptake and to detect the expression of 170-kDa multidrug resistance-mediated P-glycoprotein (MDR-Pgp).. Before chemotherapy with paclitaxel, 20 patients with stage IIIb or IV NSCLC were enrolled in this study to undergo early and delayed 99mTc-TF chest imaging for calculating tumor-to-normal lung ratios (T/NL) and retention indices (RI) for assessment of the MDR-Pgp in NSCLC.. The early and delayed mean T/NLs were 1.59 +/- 0.25 and 1.50 +/- 0.25, respectively, for 10 patients with a good response and 1.09 +/- 0.09 and 1.03 +/- 0.05, respectively, for 10 patients with a poor response. The differences were shown to be significant (P < 0.001) by independent Student t tests. However, no significant differences (P = 0.801) between good-response patients (-5.70% +/- 3.67%) and poor-response patients (-5.23% +/- 4.51%) were found in RI. In addition, other prognostic factors (age, sex, tumor size, stage, and cell type) were not significantly different between good-response patients and poor-response patients.. 99mTc-TF chest images are potential tools for understanding MDR-Pgp expression in NSCLC and for predicting the chemotherapeutic response to paclitaxel.

Topics: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; ATP Binding Cassette Transporter, Subfamily B, Member 1; Carcinoma, Non-Small-Cell Lung; Cisplatin; Drug Resistance, Multiple; Female; Humans; Lung Neoplasms; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Paclitaxel; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Thorax

Our aim was to use technetium-99m tetrofosmin (Tc-TF) uptake in non-small cell lung cancer (NSCLC) for predicting the chemotherapeutic response of NSCLC to paclitaxel and to compare the results with the expression of multidrug resistance (MDR) - P-glycoprotein (Pgp). Twenty patients with advanced NSCLC were enrolled in this study before chemotherapy with paclitaxel. Tc-TF chest imaging was performed to calculate early and delayed tumor-to-normal lung (T/NL) count-density ratios, as well as washout indexes (WIs). Immunohistochemical analyses were performed on multiple nonconsecutive sections of the biopsy specimens to detect Pgp expression. The response to chemotherapy was evaluated by clinical and radiological methods in the third month after completion of treatment. The early and delayed T/NL count-density ratios of patients with good response were significantly higher than those of patients with poor response (p <0.05). However, no significant difference in WI between the two groups of patients was found (p > 0.05). A significantly higher incidence of good response was found in patients with negative Pgp expression (100%) than in patients with positive Pgp expression (40%) (p <0.05). Significantly higher early and delayed T/NL count-density ratios as well as decreased WIs were found in patients with negative Pgp expression than in patients with positive Pgp expression. However, other prognostic factors (age, sex, body weight loss, performance status, tumor stage, and tumor cell type) were not significantly different between the patients with good response and those with poor response. Because Tc-TF chest images can correctly represent the expression of Pgp in NSCLC, it can accurately predict the chemotherapeutic response to paclitaxel.

Topics: Adult; Aged; Antineoplastic Agents, Phytogenic; ATP Binding Cassette Transporter, Subfamily B, Member 1; Carcinoma, Non-Small-Cell Lung; Humans; Immunohistochemistry; Lung; Lung Neoplasms; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Paclitaxel; Radionuclide Imaging; Radiopharmaceuticals

Topics: Aged; Antineoplastic Agents; Carcinoma, Non-Small-Cell Lung; Combined Modality Therapy; Humans; Lung Neoplasms; Male; Micronuclei, Chromosome-Defective; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Prospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed

Topics: Aged; Aged, 80 and over; ATP Binding Cassette Transporter, Subfamily B, Member 1; Carcinoma, Non-Small-Cell Lung; Female; Humans; Lung Neoplasms; Male; Middle Aged; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon

We used thoracic SPECT to study the 99mTc-tetrofosmin (TF) uptake in patients with non-small-cell-lung-carcinoma (NSCLC). The results were compared with the percentage of P-glycoprotein (Pgp) found in flow cytometric analysis (FC) of samples of surgically-resected tumor tissue.. A total of 21 patients with NSCLC were studied by means 99mTC-TF and thoracic SPECT. Image analysis included the determination of the TF uptake rate in the lung mass with respect to that of healthy tissue of the contralateral lung. These rates were compared with the percentage of Pgp expression according to FC. FC analysis was also carried out in 16 samples of healthy lung tissue obtained from the patients.. In healthy lung tissue, the mean Pgp expression according to FC was 4.58 +/- 1.87%. The cutoff value used to differentiate between Pgp positive and Pgp negative tumors was considered to be the mean plus two standard deviations (8.32). The Pgp-positive tumors (> 8.32%) presented significantly lower uptake levels (1.28 +/- 0.39) than the Pgp-negative lesions (1.66 +/- 0.33) (p = 0.029).. There is a inverse correlation between the Pgp expression as determined by FC analysis and 99mTc-TF in NSCLC. Thus, this radiopharmaceutical provides rapid and non-invasive information on Pgp expression in these lesions.

Topics: Adenocarcinoma; Adult; Aged; ATP Binding Cassette Transporter, Subfamily B, Member 1; Carcinoma, Adenosquamous; Carcinoma, Non-Small-Cell Lung; Carcinoma, Squamous Cell; Drug Resistance, Multiple; Drug Resistance, Neoplasm; Female; Flow Cytometry; Humans; Lung; Lung Neoplasms; Male; Middle Aged; Neoplasm Proteins; Organophosphorus Compounds; Organotechnetium Compounds; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon