Distribution Of Extrathoracic Metastases And EGFR Gene Mutation In Bone Metastases Of Newly Diagnosed Advanced NSCLC Based On Glycometabolism Imaging

Chapter 1 Clinical study of the distribution of extrathoracic metastases in newly diagnosed advanced NSCLC based on 18F-FDG PET/CTObjective:The purpose of this study was to analyze the distribution and characteristics of extrathoracic metastases on 18F-FDG PET/CT imaging of newly diagnosed advanced NSCLC,to provide clinical data for screening,diagnosis and treatment of extrathoracic metastases of advance lung cancer.Methods:From January 2017 to April 2018,137 patients were performed '8F-FDG PET/CT imaging in our PET center and confirmed advanced NSCLC with extrathoracic metastasis(M1b or M1c).Besides 18F-FDG PET/CT whole body scan,skull expert mode scan,CT or MRI scan were used to confirm the presence or absence of brain metastasis.Combined with 18F-FDG PET/CT and corresponding brain examination results of all newly diagnosed advanced NSCLC patients,the characteristics of distant metastatic organs,location and number of lesions were understood.SPSS 22.0 was used for statistical analysis,Chi-square test and Fisher's exact probability method were used for analysis and comparison.Results:1.Among the 137 patients of advanced NSCLC with extrathoracic metastasis,the most easily metastatic sites were bone>brain>adrenal>distant lymph node>liver>muscle>subcutaneous>pancreas>kidney>spleen.2.There were 25 cases of single organ metastasis(M1b),accounting for 18.25%of all patients.The metastasis rates of each organ were 56.00%in bone,20.00%in brain,12.00%in adrenal gland,8.00%in muscle and 4.00%in subcutaneous.112 cases(81.75%)had multiple metastasis(Mlc)in one or more organs.3.There was no significant difference in the metastasis rates of lung adenocarcinoma and squamous cell carcinoma at common sites(P>0.05).4.Lung adenocarcinoma has the highest incidence of bone metastasis,accounting for 69.05%,spine,hipbone and rib were the most common metastasis sites.Conclusion:1.Bone metastasis was the most common extrathoracic metastasis in newly diagnosed advanced NSCLC patients,accounting for 64.96%.2.Extrathoracic metastasis of advanced NSCLC is predominantly multiple metastasis of one or more organs(Mlc).3.There was no significant difference in the metastasis rate of NSCLC among different pathological types at common sites.4.Lung adenocarcinoma has the highest incidence of bone metastasis,spine,hipbone and rib are the most common sites.Chapter 2 Optimized decalcification and EGFR mutation analysis of small specimens for targeted biopsy of bone metastases guided by PET/CTObjective:Molecular targeting therapy for epidermal growth factor receptor(EGFR)has become a standard treatment for advanced NSCLC.Bone is the most common site of extrathoracic metastasis of lung cancer,which is the most important factors to determine the prognosis and curative effect.However,whether bone metastases can be a sampling target for EGFR gene mutation detection remains unclear.The purpose of this study was to investigate whether it is clinically feasible to detect EGFR gene mutation in small biopsy specimens of bone metastases of lung cancer after optimized decalcification.Methods:From January 2013 to June 2018,127 patients of advanced lung cancer with bone metastasis were initially diagnosed by 18F-FDG PET/CT whole body imaging in our PET center.PET/CT-guided targeted bone metastases biopsy were done,and EGFR gene mutation in small biopsy specimens of bone metastases was detected.56 cases were treated with 10%nitric acid decalcification for 10-30 minutes,while 71 cases were not treated with 10%nitric acid decalcification.In this study,the mutation detection of EGFR was performed by ARMS-PCR,and all data were analyzed by SPSS 22.0,chi-square test and Fisher's exact probability method.Results:1.The total mutation rate of EGFR in 127 patients was 51.18%.2.The mutation rate of EGFR in the decalcification group was 48.21%,while that in the without decalcification group was 53.52%,P=0.552>0.05,which had no statistical significance.3.75 male patients had a positive mutation rate of 42.67%;52 female patients had a mutation rate of 63.46%,P=0.021<0.05,with statistical significance.4.Among 985 bone metastases,osteolytic lesions were the most common,accounting for 51.78%.5.Invisible lesions accounted for about 1/4.6.There were 31 cases had mutation of L858R and 29 cases had 19-del mutation,accounting for 46.15%and 44.62%of the total mutation,respectively.Conclusion:1.When the time of decalcification of 10%nitric acid was controlled within 10-30 minutes,and the mutation of EGFR was detected by ARMS-PCR,decalcification of small biopsy specimens of bone metastases had no effect on EGFR mutation detection rate.2.The mutation rate of EGFR was different in gender and was more common in women than in men.3.Among all bone metastases,osteolytic morphological changes were the most common lesions,accounting for 51.78%.4.Invisible lesions accounted for about 1/4.5.19-del and L858R were common mutation types of EGFR,accounting for more than 90%of all mutation rates,in which point mutation of L858R is more common.It is feasible to detect EGFR gene mutation in small biopsy specimens of bone metastases from lung cancer.