Tc <sup> M,,. <sup> 99 </ Sup> </ Sup> N-noet Of Spect Differential Diagnosis Of Benign And Malignant Tumors And To Detect The Clinical Value Of Lymph Node Metastasis

Objective To investigated the value of ⁹⁹Tc^mN-NOET Dual-phase SPECT in diagnosis of solitary pulmonary nodule(SPN), and compared with CT. To analyzed the early and delay T/N (tumor ROI/normal tissue ROI) of diseased region, and further analyzed it's influencing factors. To analyzed the value of ⁹⁹Tc^mN-NOET Dual-phase SPECT in measuring SPN size, and compared with CT. To differentiated the detection rate of focal by planar imaging and tomography imaging.Methods ⁹⁹Tc^mN-NOET 20-30min early planer and SPECT imaging, 2h delay planer and SPECT imaging, and CT were performed on 62 pts suspected with lung lesion before operated in one week, meanwhile 5 normal controls exclude malignant disease of lung(male/female 3/2, age 30-64yo, mean age 42.53±7.52yo) undergone the same checks. All cases didn't accept the radiotherapeutic, chemotherapeutic and operation before checks. Moreover, all pts gained the cytology or histologic data by bronchofibroscope, puncture biopsy or operation. A case was obstruction syndrome of middle lobe of right lung, pleural effusion and lower respiratory infection. It didn't include in statistics for major atelectasis in middle lobe of right lung and right pleural effusion had an influence on naked eye and semiquantitative analysis to imaging. All NOET freeze drying kit manufactured and offered by Peking normal university, radioactivate-chemistry purity >90%. ⁹⁹Tc^mN-NOET SPECT by double detecting head VERTEX manufactured by ADAC company of American. Parallel hollow, hypo-energy and high resolution collimator were used in all ⁹⁹Tc^mN-NOET SPECT. energy peak was 140KeV.window width was±20%. Partly static planar imaging gathered by 1000k counted number, matrix 256×256. Tomography getted by 360°, 6°/frame, 40s/frame, matrix 128×128, enlargement factor was 1. Data was disposed by computer software of ADAC special purpose compute and butterworth filter function (cutoff, 0.36; order, 15), then obtained transverse plane, sagittal plane and coronal plane imaging. CT check applied by CT instrument manufactured by GE company. Images of ⁹⁹Tc^mN-NOET SPECT by naked eye analysis and semiquantitative analysis. Two salted doctor of nuclear medicine concomitanc examine imaging. Pathology and ⁹⁹Tc^mN-NOET imaging compared by double blind. Naked eye analysis roughly definited the location of focus of disease through eye-measurement, X-ray and CT in the first, then observed abnormality strong radioactivity gather focus of one-by-one deck whether or not. The scores undertaked according to the imaging agent gathered degree in occupy location: no gathered was (-) and 0 score; small amounts (+) and 1 score; gathered but lower than the counted number of liver (++) and 2 scores; obviously gathered and equal to or super to the counted number of liver (+++) and 3 scores. - and + were negative, ++ and +++ positive. Semiquantitative analysis applied by region of interesting(ROI) in the planer imaging and transverse plane, sagittal plane and coronal plane tomography imaging (the obviously gathered NOET occupation: to select apparente accumulate NOET frame, then definited tumor ROI and settled opposite side normal tissues as background; the little or no gathered NOET occupation: to reference the local of disease in X-ray, CT and MRI), then drawed the tumor ROI (ROI₁) and opposite side normal tissues ROI (ROI₂), surveyed and evaluated the mean count of every pixel. The uptake relative value (T/N) is tumor counts/normal tissue counts (ROI₁/ROI₂). T/N consist of early T/N (ER) and delay T/N (DR). fraction mark of stagnation (RI%)=(DR-ER)/ER×100%. The size of local disease and cavity was measured by characteristic of computer and expressed by diameter length×diameter transversa×anteroposterior diameter. The judgement standard on the basis of naked eye analysis and semiquantitative analysis. Pulmonary malignant tumor had abnormality radioactivity accumulation of chest plane and tomography imaging, wherase pulmonary benign lesion had no radioactivity acc umulation. Statistical analysis used SPSS software (11.5). x±s expressed quantitate data and used independent Samples T test. Ratio expressed qualitation data and usedχ² analysis. The sensitivity, specificity, accurate, positive predictive value and negative predictive value of ⁹⁹Tc^mN-NOET SPECT were calculated and compared with others check. The difference and relationship of ER, DR and RI% of every groups was analyzed by repeated measurement. The differential between CT and ECT in checking disease size was analyzed by repeated measurement also. P<0.05 is statistical significance.Results (1) Fifty-one pts were classified to primary malignancy of lung (group 1, G1), whereas 10 cases with benign diseases (group 2, G2) according to pat hology. G1 had 5leases (male/female, 36/15, age 38-80yo, mean age 59.7±9.7 6yo, mean weight 64.12±10.35kg, mean height 168.43±6.72cm). G1 included in 28(28/51, 54.9%) squamous carcinoma, 13 (13/51, 25.5%) adencarcinoma, 7 (7 /51, 13.7%) small cell cancer, 2 large cell carcinoma and 1 sarcocarcinoma. G 2 had 10 cases (male/female, 2/8, age 44-61yo, mean age 55.1±6.28yo, mean weight 50.5±5.38kg, mean height 158.9±2.33cm). G2 had 7 inflammatory pseud otumour, 2 sclerosing hemangioma and 1 hamartoma. Age, weight and height of two groups was no significant difference (P>0.05). (2) 51 cases of malignan t lesions (including 28 cases of squamous cell carcinoma, 13 cases of adenocar cinoma, seven cases of small cell carcinoma, two cases of large cell carcinom a, one case of sarcoma cancer). ⁹⁹Tc^mN-NOET early lung imaging showed that94.1% (48/51) of pts with lung cancer positive, including squamous cell card noma 92.86% (26/28), adenocarcinoma 92.31% (12/13), small cell carcinoma of100% (7/7), large cell carcinoma 100% (2/2), carcinosarcoma 100% (1/1); 3 f alse negative included 2 cases of squamous cell carcinoma and one case of ad enocarcinoma.⁹⁹Tc^mN-NOET delayed imaging showed that 90.2% (46/51) of pa tients with lung cancer positive, including squamous cell carcinoma 89.3% (25/ 28), adenocarcinoma 92.31% (12/13), 85.7% of small cell carcinoma (6/7), 1arg e cell carcinoma 100% (2/2), carcinosarcoma 100% (1/1); 5 false negative incl uded 3 cases of squamous cell carcinoma, one case of adencarcinoma and onecase of small cell carcinoma. According to 4 scores as score standard, NOETearly score of pulmonary malignant lesions was 106 points (2.078±0.935), del ayed was 98 scores (2.032±1.021). 10 cases of benign nodules (including sevencases of inflammatory pseudotumour, two cases of sclerosing hemangioma, on e case of hamartoma), ⁹⁹Tc^mN-NOET early lung scintigraphy showed 70% (7/1 0) of patients negative, 3 cases showed false positive was two cases of inflam matory pseudotumour , one case of sclerosing hemangioma; ⁹⁹Tc^mN-NOET dela yed imaging showed 80% (8/10) patients negative, two cases showed that falsepositive included one case of inflammatory pseudotumor, one case of sclerosin g hemangioma. According to 4 scores as score standard, lung benign lesions sc ores was five scores for early imaging, 4 scores for delayed. CT showed that 90.2% (46/51) of patients with lung cancer positive, including 92.86% (26/28) squamous cell carcinoma, 84.62% (11/13) adenocarcinoma, 85.71% (6/7) small cell carcinoma, and 100% (2/2) large cell carcinoma, 100% (1/1) carcinosarcom a. 80% (8/10) benign nodules of patients showed negative, two cases show tha t the false positive was one case of inflammatory pseudotumor and one case o f sclerosing hemangioma. ⁹⁹Tc^mN-NOET early imaging in the differential diagno sis of benign and malignant sensitivity, specificity, positive predictive value, ne gative predictive value, and accuracy were 94.1%, 70%, 94.1%, 70%, 90.2%. ⁹⁹Tc^mN-NOET delayed imaging in the differential diagnosis of pulmonary tumor s of benign and malignant sensitivity, specificity, positive predictive value, nega tive predictive value, and accuracy were 90.2%, 80%, 95.8%, 61.5%, 88.5%. C T differential diagnosis benign and malignant sensitivity, specificity, positive pre dictive value, negative predictive value, and accuracy were 90.2%, 80%, 95.8 %, 61.5%, 88.5%. We could drawn the conclusions afterχ² analysis that there was no difference between ⁹⁹Tc^mN-NOET early imaging with ⁹⁹Tc^mN-NOET del ay imaging and CT of sensitivity and specificity in diagnosing the lung malign ant disease respectively. Therefore, ⁹⁹Tc^mN-NOET dual-phase SPECT could be used to diagnosis the lung cancer.(3)⁹⁹Tc^mN-NOET imaging early tumor/normal tissues ratio (ER) 1.25±0.15 for G1, 1.09±0.11 for G2, there was significant d ifference (P<0.001); delay tumor/normal tissues ratio (DR) 1.40±0.17 for G1, 1. 18±0.21 for G2, there was significant difference (P<0.001); retention index (RI %) 12.22±6.38 for G1, 28.3±10.91 for G2, there was no significant difference (P>0.05). The semi-quantitative indicators (ER, DR and RI%) of ⁹⁹Tc^mN-NOE T imaging had nothing to do with TNM stages, different histological types, tu mor diameter, cavity, the history of smoking and sex (P>0.05). (4) Reject no 1 ump cases of ⁹⁹Tc^mN-NOET imaging. There was 48 cases of lung cancer patie nts and two cases of patients with inflammatory pseudotumor. The length, diam eter transversa and thickness of the lesions were measured by CT, ⁹⁹Tc^mN-NOE T early imaging and ⁹⁹Tc^mN-NOET delay imaging respectively. The length resu Its of malignant lesions by CT, ⁹⁹Tc^mN-NOET early imaging and ⁹⁹Tc^mN-NOETdelay imaging were as follows: 4.34±2.9, 5.28±3.04, 5.44±3.01; the length res ults of benign lesions by CT, ⁹⁹Tc^mN-NOET early imaging and ⁹⁹Tc^mN-NOET delay imaging were as follows: 1.56±0.73, 2.78±0.29, 3.03±0.21. The diameter transversa of malignant lesions were as follows: 3.41±2.36, 4.71±2.67, 4.81±2.7 6. The diameter transversa of benign lesions were as follows: 1.28±0.61, 2.50±0.12, 2.61±0.11. The thickness of malignant lesions were as follows: 3.56±2.32,3.93±1.84, 3.92±1.81. The thickness of benign lesions were as follows: 1.29±0.5, 2.37±0.15, 2.44±0.16. We coule see that the early and delayed NOET mea surement results exceed to CT about the length, diameter transversa and thickn ess, and there were statistically significant respectively (P<0.001). NOET early and delay measurement results had slightly different, but without statistical sign ificance (P>0.05). The minimum value measured by CT, NOET early imaging and delay imaging was 0.9cm, 1.85cm and 2.37cm. (5) There was 9 lung cane er cases undergone ⁹⁹Tc^mN-NOET SPECT and planar imaging, early planar ima ging showed abnormal of three cases, delayed planar imaging showed abnormalof four cases. Early tomography showed abnormal of seven cases, delayed im aging showed abnormal of eight cases, and the lesions showed distinctness. Th e detection rate of malignant lung lesions by ⁹⁹Tc^mN-NOET early imaging was77.8% (7/9), superior to planar imaging 33.3% (3/9) (P<0.05). The detection r ate of malignant lung lesions by ⁹⁹Tc^mN-NOET delay imaging was 88.9% (8/ 9), superior to planar imaging 44.4% (4/9) (P<0.05). ER (1.23±0.11) and DR (1.42±0.21) of ⁹⁹Tc^mN-NOET tomography were obviously exceed to ER (1.18±0.15) and DR (1.27±0.16) of ⁹⁹Tc^mN-NOET planar imaging. There were signifi cant difference between tomography with planar about ER and DR respectively(P<.001).Conclusion ⁹⁹Tc^mN-NOET dual-phase SPECT could be used to diagnosis the lung cancer and there was no significant difference between ⁹⁹Tc^mN-NOET dual-phase SPECT with CT. The measurement results by ⁹⁹Tc^mN-NOET exceed to CT. The detection rate of malignant lung lesions by ⁹⁹Tc^mN-NOET early imaging superior to planar imaging. The semi-quantitative indicators (ER, DR and RI%) of ⁹⁹Tc^mN-NOET imaging had nothing to do with TNM stages, different histological types, tumor diameter, cavity, the history of smoking and sex (P>0.05). Objective To investigate the value of ⁹⁹Tc^mN-NOET dual-phase SPECT in detection mediatinal lymphnode metastasis of pts with lung cancer. The results were compared with that of computed tomography (CT). Through this research in order to provide a new view to accurate preoperative staging of lung cancer and help to choose appropriate clinical treatment.Methods 29 pts with proved lung cancer underwent surgeries, including 17 cases of squamous cell carcinoma, 7 cases of adenocarcinoma, 4 cases of small cell carcinoma, 1 case of large cell carcinoma. Males/females, 21/8. Mean age was 57.42±8.84yo. According to pathologically results, 29 pts divided into two groups: 11 cases with mediastinal lymphnode metastasis as one group (group 1, G1), male/female, 7/4, the average age of 55.55±10.27yo, the total of 34 mediastinal lymphnode metastasis; 18 cases without mediastinal lymphnode metastasis as another group (group 2, G2), male/female, 12/6, the average age 58.56±7.94yo. Major equipments, ⁹⁹Tc^mN-NOET SPECT imaging and the statistical analysis methods the same as the first part of the first quarter. To determine whether there is any lymphnode metastasis according to the abnormal imaging agent concentration of nodus lymphaticus of axillary space, mediastinum and cervical part.Results (1)⁹⁹Tc^mN-NOET early lung imaging showed that 72.7% (8/11) pts in G1 with mediastinal lymphnode metastasis, 3 false negative cases included two cases of small cell carcinoma and one case of squamous cell carcinoma. ⁹⁹Tc^mN-NOET early lung imaging showed that 77.8% (14/18) pts in G2 without mediastinal lymphnode metastasis, 4 false-positive cases were I b period of squamous cell carcinoma. ⁹⁹Tc^mN-NOET delay imaging showed that 45.4% (5/11) of patients with mediastinal lymphnode metastasis. ⁹⁹Tc^mN-NOET delay lung imaging showed that 88.9% (16/18) pts in G2 without mediastinal lymphnode metastasis. The CT showed that 54.5% (6/11) of patients with mediastinal lymphnode metastasis, 5 false-negative cases included two cases of small cell carcinoma, one case of large cell carcinoma, one case of adenocarcinoma and one case of squamous cell carcinoma, three false-positive cases included the two cases ofâ…¡a period of squamous cell carcinoma and one case ofâ…¢a squamous cell carcinoma. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ⁹⁹Tc^mN-NOET early imaging differential diagnosis of mediastinal lymphnode metastasis were 72.7%, 77.8%, 66.7%, 82.4%, 75.9% respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of ⁹⁹Tc^mN-NOET delay imaging differential diagnosis of mediastinal lymphnode metastasis were 45.5%, 88.9%, 72.4%, 71.4%, 72.7%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT scan differential diagnosis of mediastinal lymphnode metastasis were 54.5%, 83.3%, 66.7%, 75%, 72.4%. We could drawn the conclusions afterχ² analysis that there was no difference between ⁹⁹Tc^mN-NOET early imaging with CT of sensitivity and specificity in diagnosing the mediastinal lymphnode metastasis of lung cancer respectively. ⁹⁹Tc^mN-NOET delay imaging with CT of sensitivity and specificity in diagnosing the mediastinal lymphnode metastasis of lung cancer respectively.⁹⁹Tc^mN-NOET early imaging with ⁹⁹Tc^mN-NOET delay imaging of sensitivity and specificity in diagnosing the mediastinal lymphnode metastasis of lung cancer respectively. Therefore, ⁹⁹Tc^mN-NOET dual-phase SPECT could be used to detecting mediastinal lymphnode metastasis of lung cancer. (2) ER of G1 was 1.26±0.11, DR of G1 was 1.38±0.15; ER of G2 was 1.28±0.17, DR of G2 was 1.43±0.22. Not only ER but also DR, G2 higher than G1, that indicated that tumor excretion NOET slower than contralateral lung tissue with the time prolong, regardless of whether mediastinal lymphnode metastasis. There was statistically different (P<0.001). However, while ER, DR and RI% of G2 higher than G1, and no significant difference respectively (P>0.05). This was a cue to illustrate the lung lesion uptake NOET had nothing to do with mediatinal lymphnode metastasis.Conclusions ⁹⁹Tc^mN-NOET dual-phase SPECT could be used to detecting mediastinal lymphnode metastasis of lung cancer and there was no difference with CT. The semiquantitative indexes (ER, DR and RI%) had nothing to do with mediatinal lymphnode metastasis. Moreover, we found that the lung lesion washed out NOET slower than opposite side normal lung in spite of mediatinal lymphnode metastasis with the time prolong after injection. Objective To investigate the value of ⁹⁹Tc^mN-NOET SPECT semi-quantitative indexes in early predicting the chemotherapy reaction in lung cancer.Methods A total of 22 cases of 51 pts with lung malignant lesions underwent chemotherapy after early and delay ⁹⁹Tc^mN-NOET SPECT. They were used MVP or IVP chemotherapy programme and each patients received 2 courses of chemotherapy, chemotherapy drugs were used intravenous. The curative effect judgement on the base of WHO standards. 22 cases were divided into relieve groups and non-relieve groups according to the recheck results of CT and clinical evaluation after two course of chemotherapy. Relieve group (group 1, G1) including complete relieve (CR) and partial remission (PR) had 9 cases, male/female 6/3, mean age 59.67±10.16yo. Non-relieve groups (group 2, G2) including non-response (NR) and proliferation had 13 cases, male/female 10/3, mean age 58.00±5.55yo. Then compared the difference of T/N before chemotherapy in two groups. Major equipments, ⁹⁹Tc^mN-NOET SPECT imaging and statistical analysis of part the same as the first part of the first chapter.Results The value of early T/N ratio (ER) and delayed T/N ratio (DR) in G1 was 1.42±0.13 and 1.58±0.10; in G2 was 1.26±0.15 and 1.40±0.22. ER and DR of relieve group significant higher non-relieve group (P<0.05, respectively). This was a cue to illustrate the higher of T/N before chemotherapy, the better of curative effect. The value of RI% was 11.56%±7.55% in Gl, 13.92%±6.61% in G2. The value of RI% in G2 higher than G1, but there had no significant difference (P>0.05). This was possibily due to lung lesion in relieve groups washed out NOET faster than non-relieve groups (P>0.05).Conclusions The semiquantitative indexes (ER and DR) of ⁹⁹Tc^mN-NOET SPECT may be effective method for early predicting the chemotherapy reaction in lung cancer. Objective To initial investigate the value of ⁹⁹Tc^mN-NOET Dual-phase SPECT in diagnosis of breast lesions. The results were compared with that of mammography and ultrasound. To analyzed the detection rate about breast cancer of planar imaging and tomography respectively. Through this research topics, we hoped to provide a non-invasive, practical and new detection methods for preoperative diagnosis of breast cancer, orientate during operation, condition analysis and clinical efficacy of treatment program.Methods X-ray mammography examination, early and delay ⁹⁹Tc^mN-NOET SPECT imaging were performed on 25 female pts by clinical breast palpation method suspected with breast lesion within one week before operated. All pts didn't recept radiotherapy, chemotherapy and surgery before checks. All pts had surgery, biopsy histology or cytology information. Among them, one case of postoperative pathology confirmed lymphoma didn't included in the statistics. The remaining 24 cases were divided into malignant group (group 1, G1) and benign group (group 2, G2) according to pathology. G1 had 19 cases (mean age 51.32±4.97yo, average weight 59.95±8.30kg, average height 157.89±5.39cm) who were invasive ductal carcinoma, including 2 cases in stage 1,17 cases in stageâ…¡; 6 cases with axillary lymphnode metastasis. G2 had 5 cases (mean age 48.80±4.55yo, average weight 50.5±5.38kg, average height 157.6±4.39cm) who were fibroadenoma. There was no significant difference between two groups about age, height and weight respectively (P>0.05). Major equipments, ⁹⁹Tc^mN-NOET SPECT imaging and statistical analysis of part the same as the first part of the first chapter.Results(1)⁹⁹Tc^mN-NOET early and delayed imaging showed that 89.5% (17/19) patients in G1 with positive imaging. The two cases with false-negative was one case in stageâ… , one case in stageâ…¡, the diameter of lesions were little than lcm. According to the judgement of 4 scores, ⁹⁹Tc^mN-NOET early imaging showed 35 (2.05±1.12) scores; ⁹⁹Tc^mN-NOET delayed imaging 34 (1.95±1.12) scores. ⁹⁹Tc^mN-NOET early showed that 80% (4/5) patients in Gl with negative imaging. 1 case with false-positive showed tumor diameter exceed 2cm. According to the judgement of 4 scores, ⁹⁹Tc^mN-NOET early imaging showed 3 scores. ⁹⁹Tc^mN-NOET delayed imaging showed 100% (5/5) patients negative. According to the judgement of 4 scores, ⁹⁹Tc^mN-NOET delayed imaging showed 1 score. The results of mammography showed that 84.2% (16/19) of patients in G1 with positive results, 80% (4/5) patients in G2 showed negative, 1 false-positive patients showed tumor diameter exceed 2cm. ⁹⁹Tc^mN-NOET early imaging in the differential diagnosis of benign and malignant sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 89.5%, 80%, 94.4%, 66.7%, 87.5%. ⁹⁹Tc^mN-NOET delayed imaging in the differential diagnosis of pulmonary tumors of benign and malignant sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 89.5%, 100%, 100%, 71.4%, 91.7%. X-ray mammography differential diagnosis benign and malignant sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 84.2%, 80%, 94.1%, 57.1%, 83.3%. We could drawn the conclusions afterχ^analysis that there was no difference between ⁹⁹Tc^mN-NOET early imaging with X-ray mammography of sensitivity and specificity in diagnosing the breast cancer respectively. There was no difference between ⁹⁹Tc^mN-NOET delay imaging with X-ray mammography of sensitivity and specificity in diagnosing the breast cancer respectively. Therefore. ⁹⁹Tc^mN-NOET dual-phase SPECT could be used to diagnosed the breast cancer. (2) The value of ER in G1 and G2 was 1.45±0.27 and 1.13±0.18; the value of DR in G1 and G2 was 1.67±0.32 and 1.03±0.25; the retention index (RI%) of G1 and G2 was 15.74±11.55 and -9.29±18.40, the difference was significant respectively (P<0.05). The results showed that ER, DR and RI% in G1 higher than G2, there was significant difference between two groups of every semi-quantitative index respectively (P<0.05). Meanwhile, ER and DR had significant difference respectively in every group (P<0.05). That indicated that malignant lesions uptaked NOET more than benign lesions. (3) 19 cases of breast cancer including 16 cases with tumor diameter exceed 2cm and 3 cases with tumor diameter little than 2cm. The value of ER, DR and RI% had no statistically different between G1 and G2 respectively (P>0.05). That indicated that breast tumor uptaked NOET had nothing with the size of lumps. (4) The length of the lesion signify the size of tumor. Reject no lump cases of ⁹⁹Tc^mN-NOET imaging, ultrasound and mammography. There was 14 cases of breast cancer patients and 1 case of fibroadenoma who's lesion diameter exceed 2cm. The length of the lesions were measured by ⁹⁹Tc^mN-NOET early imaging, ⁹⁹Tc^mN-NOET delay imaging, ultrasound, mammography and specialist examination respectively. There was significant difference (P<0.01). The minimum lengths measured by ⁹⁹Tc^mN-NOET early imaging, ⁹⁹Tc^mN-NOET delay imaging, ultrasound, mammography and specialist examination were 1.56cm, 1.50cm, 1.55cm, 1.50cm and 2.0cm respectively. (5) There was 6 breast cancer cases undergone ⁹⁹Tc^mN-NOET SPECT and planar imaging, early planar imaging showed abnormal of 2 cases, delayed planar imaging showed abnormal of 3 cases. Early tomography showed abnormal of 5 cases, delayed imaging showed abnormal of 4 cases, and the lesions showed distinctness. The detection rate of malignant breast lesions by ⁹⁹Tc^mN-NOET early imaging was 83.3% (5/6), superior to planar imaging 33.3% (2/6) (P<0.05). The detection rate of malignant breast lesions by ⁹⁹Tc^mN-NOET delay imaging was 66.7% (4/6), superior to planar imaging 50.0% (3/6) (P<0.05). ER ((1.71±0.30) and DR (1.91±0.37) of ⁹⁹Tc^mN-NOET tomography were obviously exceed to ER (1.46±0.26) and DR (1.48±0.30) of ⁹⁹Tc^mN-NOET planar imaging. There were significant difference between tomography with planar about ER and DR respectively (P<0.05).Conclusions ⁹⁹Tc^mN-NOET dual-phase SPECT could be used to diagnosed the breast cancer and there was no difference with X-ray mammography. The semi-quantitative index was a effective method to differentiating benign and malignant breast lesions, moreover, it couldn't be influenced by tumor size. ⁹⁹Tc^mN-NOET tomographic imaging manifest super to planar imaging in detection malignant disease. Objective To investigate the value of ⁹⁹Tc^mN-NOET dual-phase SPECT in detectioning axillary nodes metastasis of pts with breast cancer and compare with ultrasound and mammography. We plan to provide a new view to accurate preoperative staging of breast cancer and help choose appropriate clinical treatment.Methods 19 female pts with proved breast cancer underwent surgeries. According to pathologically results, 19 pts was divided into two groups: 6 cases of invasive ductal carcinoma at the stage ofâ…¡with axillary lymphnode metastasis as one group (group 1, G1), mean age 49.67±5.43yo, average weight 59.83±5.530kg, average height 155.67±1.97cm; 13 cases of invasive ductal carcinoma without axillary lymphnode metastasis as other group (group 2, G2), mean age 52.08±4.77yo, average weight 158.92±6.20kg, average height 60.00±9.51cm. G2 had 2 cases at the stage of 1,11 cases at the phaseâ…¡. There was no significant difference between two groups of age, height and weight respectively (P>0.05). To observed the bilateral axillary lymphnode imaging agent distribution in the ⁹⁹Tc^mN-NOET early and delay imaging and calculated the target/non-target ration (T/N), including early T/N (ER) and delayed T/N (DR). Then to calculate the retention index (RI%). Major equipments, ⁹⁹Tc^mN-NOET SPECT imaging and the statistical analysis methods the same as the first part of the first quarter.Results (1) ⁹⁹Tc^mN-NOET early imaging showed that 83.3% (5/6) patients of G1 with axillary lymphnodes metastasis. ⁹⁹Tc^mN-NOET delay imaging showed 66.7% (4/6) patients of Gl with axillary lymphnode. Ultrasound and mammography showed 50% (3/6) and 66.7% (4/6) patients of G1 with axillary lymphnode. ⁹⁹Tc^mN-NOET early imaging showed that 76.9% (10/13) of patients in G2 without axillary lymphnode. ⁹⁹Tc^mN-NOET delay imaging showed 84.6% (11/13) of patients in G2 negative. Ultrasound and mammography showed 53.8% (7/13) and 61.5% (8/13) of patients in G2 without axillary lymphnode. The sensitivity, specificity and accuracy of ⁹⁹Tc^mN-NOET early imaging differential diagnosis of axillary lymphnode metastasis were 83.3%, 76.9%, 78.9% respectively. The sensitivity, specificity and accuracy of ⁹⁹Tc^mN-NOET delay imaging differential diagnosis of axillary lymphnode metastasis were 66.7%, 84.6%, 78.9%. The sensitivity, specificity and accuracy of ultrasound differential diagnosis of axillary lymphnode metastasis were 50%, 53.8%, 52.6%. The sensitivity, specificity and accuracy of mammography differential diagnosis of axillary lymphnode metastasis were 66.7%, 61.5%, 63.2%. We could drawn the conclusions afterχ² analysis that there was no difference between ⁹⁹Tc^mN-NOET early imaging with ultrasound and X-ray mammography of sensitivity and specificity in differential diagnosis of axillary lymphnode metastasis respectively. There was no difference between ⁹⁹Tc^mN-NOET delay imaging with ultrasound and X-ray mammography of sensitivity and specificity in differential diagnosis of axillary lymphnode metastasis respectively. Therefore, ⁹⁹Tc^mN-NOET dual-phase SPECT could be used to detecting the axillary lymphnode metastasis of pts with breast cancer. (2) The value of early T/N ratio (ER) in G1 and G2 was 1.59±0.32 and 1.39±0.23; delay T/N ratio (DR) was 1.77±0.36 and 1.63±0.31. DR was higher than ER of two groups respectively. This means the breast cancer washed out NOET slower than opposite side normal breast in spite of with or without axillary nodes metastasis with the time prolong after injection (P<0.05). However, the value of ER, DR and RI% in two groups were no significiant difference respectively (P>0.05), this was a cue to illustrate the breast lesion uptake NOET had nothing to do with axillary nodes metastasis. (3) There was 6 cases of patients with breast cancer underwent ⁹⁹Tc^mN-NOET SPECT and planar imaging, including 3 cases of postoperative pathology confirmed with axillary lymphnode metastasis. ⁹⁹Tc^mN-NOET early and delayed planar imaging had no axillary lymphnode metastasis. ⁹⁹Tc^mN-NOET early tomography showed that 2 cases with axillary lymphnode metastasis. ⁹⁹Tc^mN-NOET delay imaging showed that 1 cases with axillary lymphnode metastasis.tConclusions ⁹⁹Tc^mN-NOET dual-phase SPECT could be used to detecting the axillary lymphnode metastasis of pts with breast cancer, and there was no difference with ultrasound and mammography. The breast lesion uptake NOET had nothing to do with axillary nodes metastasis. The breast cancer washed out NOET slower than opposite side normal breast in spite of axillary nodes metastasis with the time prolong after injection. Objective To initial investigate the value of ⁹⁹Tc^mN-NOET SPECT in diagnosis of benign and malignant of thyroid "cool or cold" nodules.Methods ⁹⁹Tc^mN-NOET SPECT was performed on 33 pts who had "cool or cold nodule" within two weeks before operated. ⁹⁹Tc^mO₄^-and ⁹⁹Tc^mN-NOET SPECT had been done every other day. Two cases (1 case of papillary carcinoma, 1 case of follicle carcinoma) done the ⁹⁹Tc^m-MIBI SPECT also. All pts had pathology results after operated. The characters of the nodules were defined by images and the semiquantitative measurements of T/N. Major equipments, ⁹⁹Tc^mN-NOET SPECT imaging and the statistical analysis methods the same as the first part of the first quarter.Results (1) All pts was divided into two groups on the base of pathology. 16 patients were found with malignant (group 1, G1), male/female, 1/15, age from 24 to 78 yo, mean age 51.81±15.34yo), including 5 cases of papillary carcinoma, 9 cases of follicular carcinoma and 2 cases of medullary. Whereas 17 cases with benign diseases (group 2, G2), male/female, 2/15, age from 23 to 78 yo, mean age 49.65±12.24 yo, including 17 cases of adenomas. The value of T/N in G1 and G2 was 1.57±0.38 and 1.05±0.36 (P<0.001). The threshold value of ⁹⁹Tc^mN-NOET SPECT was 1.3 to diagnosis thyroid cancer. (2) There was 14 cases of thyroid cancer filled NOET, 2 cases part filled NOET. Which one case of ⁹⁹Tc^m-MIBI imaging showed that radioactive filled. There were 10 cases with 2 scores, 6 cases with 3 scores of ⁹⁹Tc^mN-NOET imaging. The total of scores was 38 scores. There was 15 cases of benign lesions unfilled NOET, 2 cases of benign lesions neighboring filled NOET and the central unfilled. Which one case of ⁹⁹Tc^m-MIBI imaging showed that radioactive unfilled. (3) The value of T/N of thyroid cancer was 1.57±0.38, thyroid adenoma was 1.05±0.36. There was significant between benign and malignant group (F= 16.095, P<0.001). The mean value of thyroid cancer T/N ((?)-1.64 s) and benign lesions T/N ((?)+1.64 s) could be as the threshold values to determine the mass of benign and malignant. Therefore, the threshold value of ⁹⁹Tc^mN-NOET imaging for judging thyroid mass of benign and malignant was 1.3.Conclusions The semiquantitative index of ⁹⁹Tc^mN-NOET SPECT may be to diagnosis thyroid cancer.