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

Öz

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.

Anahtar Kelimeler

• 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.

Kaynakça

1. Arseven O. Akciğer Hastalıkları Ders Kitabı. İstanbul: Nobel Tıp Kitabevleri; 2019. 156.
2. Junqueira L. C., Mescher A. L. Junqueira’s basic histology: text & atlas. 13th edition. Mescher AL, editor. New York: McGraw-Hill Medical; 2013;348–60.
3. Bom H-S, Kim Y-C, Song H-C, Min J-J, Kim J-Y, Park K-O. Technetium-99m-MIBI uptake in small cell lung cancer. J. Nucl. Med. 1998;39(1):91–4.
4. Nishiyama Y, Yamamoto Y, Fukunaga K, Kiuchi T, Satoh K, Takashima H, et al. Evaluation of radiotherapeutic response in non-small cell lung cancer patients by technetium-99m MIBT and thallium-201 chloride SPET. Eur J Nucl Med. 2000;27(5):536–41.
5. Bahk Y, Kim E, Isawa T. Nuclear imaging of the chest. 2012;197–212.
6. Ell PJ, Gambhir SS. Nuclear Medicine in Clinical Diagnosis and Treatment. J. Nucl. Med. 2005;46(8):1402–3.
7. Schad F, Thronicke A, Steele ML, Merkle A, Matthes B, Grah C, et al. Overall survival of stage IV non-small cell lung cancer patients treated with Viscum album L. in addition to chemotherapy, a real-world observational multicenter analysis. PLoS One. 2018 Aug 1;13(8).
8. Topuz E, Aydıner A, Ece T, Taş F. Küçük Hücreli Dışı Akciğer Kanseri Tanı Ve Tedavi Rehberi. 2001.

9. Aydıner A, Topuz E. Akciğer Kanseri Tanı-Tedavi-Takip 2007 Nobel Tip Kitabevleri. İstanbul Üniversitesi Onkoloji Enstitüsü İstanbul Tıp Fakültesi Tıbbi Onkoloji Bilim Dalı, İstanbul Konsensusu. 2006;3–44.
10. Malik D, Sood A, Parmar M, Sood A, Radotra B, Mittal B. Incidental detection of bronchial carcinoid on Tc-99m sestamibi SPECT/CT myocardial perfusion scintigraphy. J Nucl Cardiol. 2017 Feb 1;24(1):319–22.
11. Nishiyama Y, Kawasaki Y, Yamamoto Y, Fukunaga K, Satoh K, Takashima H, et al. Technetium-99m-MIBI and thallium-201 scintigraphy of primary lung cancer. Soc Nucl Med. 1997;38:1358–61.
12. Nikoletic K, Lucic S, Peter A, Kolarov V, Zeravica R, Srbovan D. Lung 99mTc-MIBI scintigraphy: impact on diagnosis of solitary pulmonary nodule. Bosn J Basic Med Sci. 2011;11(3):174–9.
13. Volterrani D, Erba P, Carrió I, Strauss H, Mariani G. Nuclear Medicine Textbook: Methodology and Clinical Applications. 2019.
14. O’Malley J, Ziessman H. Nuclear medicine and molecular imaging: the requisites e-book. 2020.
15. Saha G. Physics and radiobiology of nuclear medicine. 2012.
16. Süreyya Çerçi S, Çerçi C, Baykal B, Yıldız M, Meltem Özbek F, Nilgün Kapıcıoğlu F, et al. Meme kanserinin tespitinde Tc-99m MIBI meme sintigrafisi, mamografi ve ultrasonografi yöntemlerinin etkinliklerinin karşılaştırılması. SDÜ Tıp Fakültesi Dergisi. 2009 May;14(3):1–6.
17. Wang H, Chen XP, Qiu FZ. Correlation of expression of multidrug resistance protein and messenger RNA with 99mTc-methoxy isobutyl isonitrile (MIBI) imaging in patients with hepatocellular carcinoma. World J Gastroenterol. 2004 May;10(9):1281.
18. Aktolun Cumali, Goldsmith SJ. Nuclear Oncology. Wolters Kluwer Health; 2015. 153–178.
19. Tabuenca MJ, Vargas JA, Varela A, Salas C, Durantez A, Ortiz Berrocal J. [Correlation between 99m Tc-tetrofosmin uptake and P-glycoprotein expression in non-small-cell lung cancer]. Rev Esp Med Nucl. 1998 Jan;17(6):427–34.
20. Silov G, Erdoğan Z, Özdal A, Tutuş A, Tekin Y, Karaman H, et al. The value of Tc-99m tetrofosmin scintimammography in the assessment of P-glycoprotein in patients with breast cancer. Hell J Nucl Med. 2013 Sep;16(3):218–22.
21. Piwnica-Worms D, Kronauge JF, LeFurgey A, Backus M, Hockett D, Ingram P, et al. Mitochondrial localization and characterization of 99Tc-SESTAMIBI in heart cells by electron probe X-ray microanalysis and 99Tc-NMR spectroscopy. Magn Reson Imaging. 1994 Jan;12(4):641–52.
22. Strauss HW, Mariani G, Volterrani D, Larson SM, Nappi C, Mansi L, et al. H. William Strauss, Giuliano Mariani, Duccio Volterrani, Steven M. Larson (editors): Nuclear Oncology: From Pathophysiology to Clinical Applications, second edition. Eur. J. Nucl. Med. Mol. Imaging. 2018 Jan;45(5):890.
23. Mueller S, Paas M, Guth-Tougelidis B, Reiners C, Budach W, Konietzko N, et al. Tc-99m MIBI and Tl-201 uptake in bronchogenic carcinomas. Nuklearmedizin (Stuttgart); (Germany, Federal Republic of). 1989;28:2:36–7.
24. Yüksel M, Çermik T, Doğanay L, … CK. 99mTc-MIBI SPET in non-small cell lung cancer in relationship with Pgp and prognosis. Springer. 2002;29(7):876–81.
25. Waxman A.D. Thallium-201 and technetium-99m methoxy isobutyl isonitrile (MIBI) in nuclear oncology. Diagnostic Nuclear Medicine. 2003;931–47.
26. Muller SP, Reiners C, Paas M. Tc-99m MIBI and Tl-201 uptake in bronchial carcinoma. J Nucl Med. 1989;30:845.
27. Tonami N, Shuke N, Yokoyama K, Seki H, Takayama T, Kinuya S, et al. Thallium-201 single photon emission computed tomography in the evaluation of suspected lung cancer. Soc Nuclear Med. 1989;30(6):997–1004.
28. Tonami N, Yokoyama K, Shuke N, Taki J, Kinuya S, Miyauchi T, et al. Evaluation of suspected malignant pulmonary lesions with 201Tl single photon emission computed tomography. Nucl Med Commun. 1993 Jul;14(7):602–10.
29. Suga K, Kume N, Orihashi N, Nishigauchi K, Uchisako H, Matsumoto T, et al. Difference in 201Tl accumulation on single photon emission computed tomography in benign and malignant thoracic lesions. Nucl Med Commun. 1993 Dec;14(12):1071–8.
30. Sehweil AM, McKillop JH, Milroy R, Sayed MA, Ziada G, Banham SW, et al. 201Tl scintigraphy in the staging of lung cancer, breast cancer and lymphoma. Nucl Med Commun. 1990 Apr;11(4):263–9.
31. Duman Y, Burak Z, Erdem S, Tufan M, Ünlü M, Haydaroğullari A, et al. The value and limitations of 201Tl scintigraphy in the evaluation of lung lesions and post-therapy follow-up of primary lung carcinoma. Nucl Med Commun. 1993 Jun;14(6):446–53.
32. Chin BB, Zukerberg BW, Buchpiguel C, Alavi A. Thallium-201 Uptake in Lung Cancer. J. Nucl. Med. 1995;36(8).
33. Saha GB. Fundamentals of Nuclear Pharmacy. Seventh Edition. Cham: Springer International Publishing; 2018. 93–122.
34. Elahi N, Bayar N, Caner B, Önerci M, Bekdik C. Imaging of an Undifferentiated Epidermoid Carcinoma with Tc-99m MIBI. Clin. Nucl. Med. 1995;20(5):467–8.
35. Caner B, Kitapcl M, Unlu M, Erbengi G, Calikoglu T, Gogus T, et al. Technetium-99m-MIBI uptake in benign and malignant bone lesions: a comparative study with technetium-99m-MDP. J Nucl Med. 1992 Mar;33(3):319–24.
36. Hassan IM, Sahweil A, Constantinides C, Mahmoud A, Nair M, Omar YT, et al. Uptake and kinetics of Tc-99m hexakis 2-methoxy isobutyl isonitrile in benign and malignant lesions in the lungs. Clin Nucl Med. 1989 May;14(5):333–40.
37. Aktolun C, Bayhan H, Pabuccu Y, Bilgic H, Acar H, Koylu R. Assessment of tumor necrosis and detection of mediastinal lymph node metastasis in bronchial carcinoma with technetium-99m sestamibi imaging: Comparison with CT scan. Lung Cancer. 1995;1–2(12):129–30.
38. Aktolun C, Bayhan H, Celasun B, Kir MK. Unexpected uptake of technetium 99m hexakis-2-methoxy-isobutylisonitrile in giant lymph node hyperplasia of the mediastinum (Castleman’s disease). Eur. J. Nucl. Med. 1991 Oct;18(10):856–9.
39. Aktolun C, Bayhan H. Tc-99m MIBI uptake in pulmonary sarcoidosis. Preliminary clinical results and comparison with Ga-67. Clin Nucl Med. 1994 Dec;19(12):1063–5.
40. LeBouthiller G, Taillefer R, Lambert R, Bavaria G, Duranceau A, LaFountaine M, et al. Detection of Primary Lung-Cancer with Tc-99m SestaMIBI. J Nucl Med. 1993;34(5):140.