KÜÇÜK HÜCRELİ DIŞI AKCİĞER TÜMÖRLERİNİN DEĞERLENDİRİLMESİNDE Tc-99m MIBI SPECT’İN YERİ

Abstract

Amaç: Bu çalışmada, Tc-99m MIBI sintigrafisinin küçük hücreli dışı akciğer kanserlerinin tanısında ve değerlendirilmesindeki yerini araştırmak ve ayrıca metastazlarının tespitinde MIBI sintigrafîsi ve MDP kemik sintigrafisinin birlikte kullanılabilirliğini değerlendirmek amaçlandı. Materyal ve Metot: Bu amaçla, 30 küçük hücreli dışı akciğer kanseri hastası ve 15 akciğer kanseri dışında benign lezyonu olan (kontrol grubu olarak) hasta çalışmaya dahil edildi. Benign ve malign akciğer lezyonu olan tüm hastalara Tc-99m MIBI ve Tc-99m MDP sintigrafisi uygulanarak ön-arka planar ve SPECT MIBI görüntüleri elde edildi. Kemik sintigrafisi tüm vücut görüntüleme şeklinde yapıldı. Sintigrafik bulgular hastaların histopatolojik tanıları ile karşılaştırıldı. Veriler istatistiksel olarak analiz edildi. Bulgular: Elde edilen bulgulara göre, Tc-99m MIBI sintigrafisinin küçük hücreli dışı akciğer tümörlerinin tespitindeki sensitivitesi %87, spesifisitesi %93,5, pozitif prediktif değeri %96, negatif prediktif değeri %77,7 ve doğruluk oranı %88,8 olarak belirlendi. Sintigrafik bulgular sayısal ve görsel olarak değerlendirildi. Planar MIBI görüntüleri kullanılarak yapılan sayısal değerlendirmede, küçük hücreli dışı akciğer tümörleri ile benign lezyonların erken tutulum oranları arasında istatistiksel olarak anlamlı bir fark bulunmazken, küçük hücreli dışı akciğer tümörlü lezyonlarda geç dönemdeTc-99m MIBI tutulum oranları iyi huylu lezyonlardan anlamlı derecede yüksekti. Bununla birlikte, SPECT görüntülerinin sayısal değerlendirmesinde hem erken hem de geç tutulum oranlarının malign lezyonlarda benign lezyonlara göre anlamlı derecede yüksek olduğu tespit edildi. Görsel washout analizlerinde ise, benign lezyonlardaki MIBI washoutunun malign lezyonlara göre yüksek düzeyde olduğu izlendi. Ayrıca, küçük hücreli dışı akciğer kanserli olan hastalarda kemik sintigrafileri görsel olarak değerlendirildiğinde; 14 hastada multipl kemik metastazı izlendi. Lezyon bölgesinde veya lezyon dışındaki yumuşak dokuda Tc-99m MDP tutulumu izlenmedi. Sonuç: Elde edilen bulguların ışığında, Tc-99m MIBI sintigrafisinin küçük hücreli dışı akciğer tümörlerinin benign lezyonlardan ayırımında kullanılabilecek, yüksek sensitivite ve spesifısiteye sahip non-invazif yöntem olduğu sonucuna varıldı.

Keywords

• Küçük hücreli dışı akciğer kanseri
• planar
• SPECT
• Tc-99m MIBI
• Tc-99m MDP kemik sintigrafisi.

THE ROLE OF Tc-99m MIBI SPECT IN THE EVALUATION OF NON-SMALL CELL LUNG TUMORS

Abstract

Objective: In this study, it was aimed to investigate the role of Tc-99m MIBI scintigraphy in the diagnosis and evaluation of non-small cell lung cancers and also to evaluate the use of MIBI scintigraphy and MDP bone scintigraphy together in the detection of metastases. Methods: For this purpose, 30 patients with non-small cell lung cancer and 15 patients with benign lesions other than lung cancer (as a control group) were included in the study. By applying Tc-99m MIBI and Tc99m MDP scintigraphy to whole patients with benign and malign lung lesions, anterior-posterior planar and SPECT MIBI images were obtained. Bone scintigraphy was performed as whole-body images. Scintigraphic findings were compared with the histopathological diagnosis of patients. Data were analyzed statistically. Results: According to the result of the findings, the sensitivity, specificity, positive, predictive value, negative predictive value, and accuracy rate of Tc-99m MIBI scintigraphy in the detection of non-small cell lung tumors were determined as 87%, 93.5%, 96%, 77.7%, and 88.8%, respectively. Scintigraphic findings were evaluated quantitatively and visually. While there was no statistically significant difference between the early uptake rates of non-small cell lung tumors and benign lesions in the quantitative evaluation using planar MIBI images, late Tc-99m MIBI uptake rates were significantly higher in lesions with non-small cell lung tumors than that of benign lesions. However, it was detected that both the early and late uptake ratios were significantly higher in malign lesions than in benign lesions in the quantitative evaluation of SPECT images. It was observed that MIBI washout in benign lesions was higher than in malignant lesions in visual washout analysis. Additionally, multiple bone metastases were observed in 14 patients on the visual evaluation of bone scan of the patients with non-small cell lung cancer. Tc-99m MDP uptake was not observed in the malignant lung lesion region or in the soft tissue except the lesion. Conclusion: In light of the findings, it was concluded that Tc-99m MIBI scintigraphy is a noninvasive method with high sensitivity and specificity that can be used to differentiate non-small cell lung tumors from benign lesions.

Keywords

• Non-small cell lung cancer
• planar
• SPECT
• Tc-99m MIBI
• Tc-99m MDP bone scintigraphy.

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