The Significance Of ⁶⁸ Ga-NOTA-PRGD PET / CT In The Diagnosis And Prognosis Of Mediastinal Lymph Node Metastasis Of Non-small Cell Lung Cancer

Background and objectivePrimary bronchial lung cancer is one of the most common tumors in the world with the first place of incidence, mortality. Non-small-cell lung cancer (NSCLC) accounts for 80% of all lung cancer. Accurate clinical stage is the key to choose treatment and it can predict the prognosis. PET/CT plays an important role in the diagnosis and prognosis assessment of NSCLC. Integrin avP3 signaling regulates tumor cells’ migration, invasion, proliferation and survival. 68Ga-NOTA-PRGD2 is a tracer of PET/CT which could specificity accumulate on the lesions with high αvβ3 level. The safety and validity 68 Ga-NOTA-PRGD2 PET/CT has been shown in the former studies. It has capability in differential diagnosis of benign and malignant lesions as well as showing good significance in clinical staging. This study aims to evaluate 68 Ga-NOTA-PRGD2 PET/CT in NSCLC patients’ prognosis evaluation and the value of clinical application in future.Methods and significanceThis is a retrospective study about the patients who had taken 68 Ga-NOTA-PRGD2 PET/CT and 18F-FDG PET/CT from November 2011 to February 2013 in Peking union medical college hospital latterly diagnosis as NSCLC by pathology. We follow them and collect their clinical information and analyze 68 Ga-NOTA-PRGD2 PET/CT and 18F-FDG PET/CT’s images to find the relationship between 68 Ga-NOTA-PRGD2 PET/CT and patients’ clinical information, mediastinal lymph node metastases, prognosis, and the results of 18F-FDG PET/CT, exploring the clinical application of 68Ga-NOTA-PRGD2 PET/CT.Results1、68 Ga-NOTA-PRGD2 PET/CT shows good ability in imaging in primary region of NSCLC. SUV values were not correlated with patients’gender, pathological types but the SUVs values of 18F-FDG PET/CT.2、SUVmax, Rmax, SUVavg and N/NT values-Ravg of 68Ga-NOTA-PRGD2 PET/CT have relationship with NSCLC patients’ prognosis. Ravg≥2.99 imply the poor prognosis of statistical significance (p≤0.05).3、68 Ga-NOTA-PRGD2 PET/CT works well diagnosing metastasis lymph node in NSCLC, with higher sensitivity and specificity than 18F-FDG PET/CT. SUVb≥0.45, SUVmaxl≥1.53, SUVavgl≥1.23 can be used as thresholds diagnosing a patient with lymph nodes metastasis. The sensitivity of SUVb≥0.45 was 71.4%(95%CI 0.303～0.949) with the specificity of 88.9% (95%CI 0.639 to 0.981). The sensitivity of SUVmaxl≥1.53 was 85.7%(95%CI 0.420 to 0.992) with the specificity of 72.2%(95%CI 0.464 to 0.892). The sensitivity of SUVavgl≥1.23 was 85.7%(95%CI,0.420～0.992) with specificity of 88.9%(95%CI 0.639 to 0.710).4、SUVmaxi, SUVavgl of 68 Ga-NOTA-PRGD2 PET/CT have relationships with NSCLC patients’ prognosis. Among them, the prognosis of patients with SUVmaxl< 2.15 and SUVmaxl≥2.15 have difference of statistically significant (p≤0.05).ConclusionThis study shows significant advantages of 68Ga-NOTA-PRGD2 PET/CT in diagnosing NSCLC and metastasis lymph nodes. SUVs of 68 Ga-NOTA-PRGD2 PET/CT have relationship with NSCLC patients’ prognosis.68Ga-NOTA-PRGD2 PET/CT has a wide prospect of clinical application providing accurate and noninvasive diagnosis evidences and assessments of prognosis.