| PurposeLung cancer is one of the most common causes of cancer death in the world,and non–small cell lung cancer?NSCLC?accounts for nearly 80% of those cases.Accurate mediastinal staging is very important for selecting the best treatment plan.Angiogenesis is an important step in tumor development and metastases.Integrin ?v?3 plays a primary role in angiogenesis.18F-ALF-NOTA-PRGD2(18F-Alfatide)has been developed for positron emission tomography?PET?imaging of integrin ?v?3 which can specifically reflect the metabolism of tumor and lymph node metastases.This is a prospective study to analyze the diagnostic performance of 18F-Alfatide PET/computed tomography?CT?for detecting lymph node metastases in patients with NSCLC and to compare the diagnostic ability between 18F-Alfatide PET/CT and fluorodeoxyglucose?FDG?PET/CT.MethodsThis study has been approved by the ethics committee of Shandong Tumor Hospital.19 NSCLC patients containing 259 resected mediastinal lymph nodes who underwent 18F-Alfatide PET/CT before surgery were enrolled in this study.Among them,7 patients were performed with both 18F-Alfatide PET/CT and FDG PET/CT.The maximal and mean standardized uptake value(SUVmax,SUVmean)and SUV ratios were obtained and calculated.The pathologic results were available as gold standard.ResultsLymph node metastases were pathologically confirmed and 34 of 259 LNs were malignant.All malignant lymph nodes were successfully visualized on 18F-Alfatide PET/CT and the sensitivity,specificity,positive predictive value?PPV?,negative predictive value?NPV?and accuracy were 79.4%,96.0%,75.0%,96.9% and 93.8%,respectively.SUVmax,SUVmean and SUV ratios in malignant lymph nodes were significantly higher than in benign ones in patients with NSCLC?P<0.05?.The same result was observed in patients in adenocarcinoma and squamous cell carcinoma?P<0.05?.According to receiver operating characteristic curve analysis,the most significant parameter was SUV ratios of lymph node to muscle?AUC=0.96?.The threshold was 2.4 and its sensitivity,specificity,PPV,NPV and accuracy were 91.2%,91.6%,62.0%,98.6% and 91.5%,respectively.The pilot comparison of 18F-Alfatide PET/CT and FDG PET/CT imaging for detecting lymph node metastases in patients with NSCLC indicated that 18F-Alfatide PET/CT is better than FDG PET/CT imaging in mediastinal lymph node diagnosis.The sensitivity,specificity and accuracy of 18F-Alfatide PET/CT and FDG PET/CT were 90.0% & 80.0%,97.9% & 85.4%,96.6% & 84.5%,respectively.ConclusionOur results suggested that PET/CT with the new tracer 18F-Alfatide is potentially valuable in the diagnosis of metastatic lymph node in patients with NSCLC.Additional studies with a larger number of patients are needed to validate our findings. |
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