~(99m)Tc(V)-DMSA与~(99m)Tc-HYNIC-TOC显像诊断甲状腺髓样癌术后复发和转移价值的对比研究
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摘要
目的:该研究旨在比较~(99m)Tc(V)-DMSA与~(99m)Tc-HYNIC-TOC在定位甲状腺髓样癌(medullary thyroid carcinoma,MTC)术后复发和转移灶中的诊断价值。方法:回顾性分析2013年7月—2016年10月24例因术后复发或转移而来复旦大学附属肿瘤医院同期行~(99m)Tc(V)-DMSA(以下简称DMSA)和~(99m)Tc-HYNICTOC(以下简称TOC)显像的MTC患者。通过对比显像结果与手术病理或临床随访资料,来判断两种显像方法的应用价值。结果:基于患者的研究中,DMSA和TOC的灵敏度分别为62.5%和37.5%,差异有统计学意义(P=0.031);基于病灶(n=44)的研究中,前者灵敏度(93.2%)高于后者(43.2%)(P<0.000 1)。以降钙素水平500 pg/m L为界将病灶分成两组,当降钙素水平≤500 pg/m L(n=11)时,DMSA和TOC的灵敏度分别为81.8%和18.2%(P=0.016);当降钙素水平>500 pg/m L(n=33)时,两者灵敏度分别为97.0%和51.5%(P<0.000 1)。对于软组织病灶(n=36),DMSA灵敏度高于TOC(P<0.000 1);对于骨病灶(n=8),两者灵敏度差异无统计学意义(P=0.219)。结论:DMSA在定位MTC患者复发或转移灶中具有较高的灵敏度,优于TOC。
Objective: To compare the clinical value of ~(99m)Tc(V)-DMSA(DMSA for short) and ~(99m)TcHYNIC-TOC(TOC for short) in the detection of recurrent or metastatic medullary thyroid carcinoma(MTC). Methods: From Jul. 2013 to Oct. 2016, 24 patients with suspicious recurrent or postoperative metastatic MTC, who underwent both DMSA and TOC imaging in our hospital, were enrolled in this retrospective study. The surgical pathology or clinical follow-up data were collected in order to compare the diagnostic values of these two methods.Results: In the patient-based analysis, the sensitivity of DMSA and TOC were 62.5% and 37.5%, respectively, the difference was statistically significant(P=0.031). In the lesion-based analysis(n=44), the sensitivity of DMSA(93.2%) was statistically higher than TOC(43.2%)(P<0.000 1). Using a cut-off calcitonin value of 500 pg/m L: lesions in patients with calcitonin lower than this value(n=11), the sensitivity of DMSA and TOC were 81.8% and 18.2%, respectively(P=0.016), lesions in patients with calcitonin exceeding this value(n=33), they raised to 97.0% and 51.5%, respectively(P<0.000 1). In detecting soft tissue lesions(n=36), DMSA had higher sensitivity than TOC(P<0.000 1). Whereas, there was no statistical difference in the sensitivity for bone lesions(n=8) between two methods(P=0.219). Conclusion: DMSA has higher sensitivity than TOC in detecting the recurrence or metastatic medullary thyroid carcinoma.~(99m)~(99m)
Objective: To compare the clinical value of ~(99m)Tc(V)-DMSA(DMSA for short) and ~(99m)TcHYNIC-TOC(TOC for short) in the detection of recurrent or metastatic medullary thyroid carcinoma(MTC). Methods: From Jul. 2013 to Oct. 2016, 24 patients with suspicious recurrent or postoperative metastatic MTC, who underwent both DMSA and TOC imaging in our hospital, were enrolled in this retrospective study. The surgical pathology or clinical follow-up data were collected in order to compare the diagnostic values of these two methods.Results: In the patient-based analysis, the sensitivity of DMSA and TOC were 62.5% and 37.5%, respectively, the difference was statistically significant(P=0.031). In the lesion-based analysis(n=44), the sensitivity of DMSA(93.2%) was statistically higher than TOC(43.2%)(P<0.000 1). Using a cut-off calcitonin value of 500 pg/m L: lesions in patients with calcitonin lower than this value(n=11), the sensitivity of DMSA and TOC were 81.8% and 18.2%, respectively(P=0.016), lesions in patients with calcitonin exceeding this value(n=33), they raised to 97.0% and 51.5%, respectively(P<0.000 1). In detecting soft tissue lesions(n=36), DMSA had higher sensitivity than TOC(P<0.000 1). Whereas, there was no statistical difference in the sensitivity for bone lesions(n=8) between two methods(P=0.219). Conclusion: DMSA has higher sensitivity than TOC in detecting the recurrence or metastatic medullary thyroid carcinoma.~(99m)~(99m)
引文
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[2]SKOURA E.Depicting medullary thyroid cancer recurrence:the past and the future of nuclear medicine imaging[J].Int J Endocrinol Metab,2013,11(4):e8156-e8156.
[3]SCHLUMBERGER M,CARLOMAGNO F,BAUDIN E,et al.New therapeutic approaches to treat medullary thyroid carcinoma[J].Nat Clin Pract Endocrinol Metab,2008,4(1):22-32.
[4]SIPPEL R S,KUNNIMALAIYAAN M,CHEN H.Current management of medullary thyroid cancer[J].Oncologist,2008,13(5):539-547.
[5]黄彩平,章英剑.甲状腺髓样癌的辅助治疗[J].肿瘤,2003,23(4):336-338.
[6]章英剑,蒋长英,邵鹏,等.甲状腺髓样癌对(99m)Tc(V)-DMSA的摄取[J].核技术,1990,(11):661-665.
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[9]SAGER S,KABASAKAL L,OCAK M,et al.Clinical value of technetium-99m-labeled octreotide scintigraphy in local recurrent or metastatic medullary thyroid cancers:a comparison of lesions with 18F-FDG-PET and MIBI images[J].Nucl Med Commun,2013,34(12):1190-1195.
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[11]李毅,徐俊彦,许晓平,等.99mTc-HYNIC-TOC SPECT/CT显像探测结直肠神经内分泌肿瘤的临床价值[J].肿瘤影像学,2017,26(1):67-71.
[12]KOOPMANS K P,DE GROOT J W,PLUKKER J T,et al.18F-dihydroxyphenylalanine PET in patients with biochemical evidence of medullary thyroid cancer:relation to tumor differentiation[J].J Nucl Med,2008,49(4):524-531.
[13]IACOBONE M,NICCOLI-SIRE P,SEBAG F,et al.Can sporadic medullary thyroid carcinoma be biochemically predicted?Prospective analysis of 66 operated patients with elevated serum calcitonin levels[J].World J Surg,2002,26(8):886-890.
[14]蒋津津,许晓平,张建平,等.99mTc-HYNIC-TOC小动物SPECT/CT显像和人体内照射剂量估算[J].肿瘤影像学,2013,22(3):231-236.
[15]WELLS S A,SANTORO M.Targeting the RET pathway in thyroid cancer[J].Clin Cancer Res,2009,15(23):7119-7123.
[16]ROY M,CHEN H,SIPPEL R S.Current understanding and management of medullary thyroid cancer[J].Oncologist,2013,18(10):1093-1100.
[17]MACHENSA,DRALLEH.Pretarget edanticar for medullary thyroid carcinoma[J].J Clin Oncol,2006,24(20):e37;author reply e38.
[18]JARZAB B,DEDECJUS M,HANDKIEWICZ-JUNAK D,et al.Diagnostics and treatment of thyroid carcinoma[J].Endokrynol Pol,2016,67(1):74-107.
[19]YA M A M U R A K,S U Z U K I S,YA M A M O TO I.Differentiation of pituitary adenomas from other sellar and parasellar tumors by 99mTc(V)-DMSA scintigraphy[J].Neurol Med Chir(Tokyo),2003,43(4):181-186;discussion187.
[20]TSIOURIS S,PIRMETTIS I,CHATZIPANAGIOTOU T,et al.Pentavalent technetium-99m dimercaptosuccinic acid[99m Tc-(V)DMSA]brain scintitomography—a plausible non-invasive depicter of glioblastoma proliferation and therapy response[J].J Neuro Oncol,2007,85(3):291-295.
[21]BANDOPADHYAYA G P,GUPTA P,SINGH A,et al.99mTcDMSA(V)in evaluation of osteosarcoma:Comparative studies with 18F-FDG PET/CT in detection of primary and malignant lesions[J].ISRN Oncol,2012,2012(10):371830.
[22]CASCINI G L,CUCCURULLO V,MANSI L.The non tumour uptake of 111In-octreotide creates new clinical indications in benign diseases,but also in oncology[J].Q J Nucl Med Mol Imaging,2010,54(1):24-36.
[23]DE GROOT J W,LINKS T P,JAGER P L,et al.Impact of18F-fluoro-2-deoxy-D-glucose positron emission tomography(FDG-PET)in patients with biochemical evidence of recurrent or residual medullary thyroid cancer[J].Ann Surg Oncol,2004,11(8):786-794.
[24]DIEHL M,RISSE J H,BRANDT-MAINZ K,et al.Fluorine-18 fluorod eoxyglucosepositronemission tomography in medullary thyroid cancer:results of a multicentre study[J].Eur J Nucl Med,2001,28(11):1671-1676.
[25]JIANG J,YANG Z,ZHANG Y,et al.Clinical value of[18F]FDG-PET/CT in the detection of metastatic medullary thyroid cancer[J].Clin Imaging,2014,38(6):797-801.
[26]B E L H O C I N E T,F O I D A RT J,R I G O P,e t a l.Fluorodeoxyglucose positron emission tomography and somatostatin receptor scintigraphy for diagnosing and staging carcinoid tumours:correlations with the pathological indexes p53 and Ki-67[J].Nucl Med Commun,2002,23(8):727-734.
[27]UGUR O,KOSTAKGLU L,GULER N,et al.Comparison of 99mTc(V)-DMSA,201Tl and 99mTc-MIBI imaging in the follow-up of patients with medullary carcinoma of the thyroid[J].Eur J Nucl Med,1996,23(10):1367-1371.
[28]BARANAUSKAS Z,VALUCKAS K P,SMAILYTE G.Combined treatment and survival of medullary thyroid carcinoma patients[J].Cent Eur J Med,2010,5(4):426-430.
[29]SCHLUMBERGER M,CARLOMAGNO F,BAUDIN E,et al.New therapeutic approaches to treat medullary thyroid carcinoma[J].Nat Clin Practice Endocrinol Metab,2008,4(1):22-32.
[30]SHUKLA J,MITTAL B R.Dimercaptosuccinic acid:A multifunctional cost effective agent for imaging and therapy[J].Indian J Nucl Med,2015,30(4):295-302.
[31]MOHAMMED A A,EL-SHENTENAWY A.Advanced thyroid cancers:new era of treatment[J].Med Oncol,2014,31(7):1-8.
[32]ROBINSON B G,PAZ-ARES L,KREBS A,et al.Vandetanib(100 mg)in patients with locally advanced or metastatic hereditary medullary thyroid cancer[J].J Clin Endocrinol Metab,2010,95(6):2664-2671.
[33]PAZAITOU-PANAYIOTOU K,TIENSUU JANSON E,KOLETSA T,et al.Somatostatin receptor expression in nonmedullary thyroid carcinomas[J].Hormones(Athens),2012,11(3):290-296.
[34]PERREN A,COUVELARD A,SCOAZEC J Y,et al.ENETS consensus guidelines for the standards of care in neuroendocrine tumors:pathology-diagnosis and prognostic s t r a t i f i c a t i o n[J].N e u r o e n d o c r i n o l o g y,2 0 1 7.d o i:10.1159/000457956.
[2]SKOURA E.Depicting medullary thyroid cancer recurrence:the past and the future of nuclear medicine imaging[J].Int J Endocrinol Metab,2013,11(4):e8156-e8156.
[3]SCHLUMBERGER M,CARLOMAGNO F,BAUDIN E,et al.New therapeutic approaches to treat medullary thyroid carcinoma[J].Nat Clin Pract Endocrinol Metab,2008,4(1):22-32.
[4]SIPPEL R S,KUNNIMALAIYAAN M,CHEN H.Current management of medullary thyroid cancer[J].Oncologist,2008,13(5):539-547.
[5]黄彩平,章英剑.甲状腺髓样癌的辅助治疗[J].肿瘤,2003,23(4):336-338.
[6]章英剑,蒋长英,邵鹏,等.甲状腺髓样癌对(99m)Tc(V)-DMSA的摄取[J].核技术,1990,(11):661-665.
[7]OZKAN Z G,KUYUMCU S,UZUM A K,et al.Comparison of 68Ga-DOTATATE PET-CT,18F-FDG PET-CT and 99mTc-(V)DMSA scintigraphy in the detection of recurrent or metastatic medullary thyroid carcinoma[J].Nucl Med Commun,2015,36(3):242-250.
[8]ADAMS S,ACKER P,LORENZ M,et al.Radioisotopeguided surgery in patients with pheochromocytoma and recurrent medullary thyroid carcinoma:a comparison of preoperative and intraoperative tumor localization with histopathologic findings[J].Cancer,2001,92(2):263-270.
[9]SAGER S,KABASAKAL L,OCAK M,et al.Clinical value of technetium-99m-labeled octreotide scintigraphy in local recurrent or metastatic medullary thyroid cancers:a comparison of lesions with 18F-FDG-PET and MIBI images[J].Nucl Med Commun,2013,34(12):1190-1195.
[10]CZEPCZYNSKI R,PARISELLA M G,KOSOWICZ J,et al.Somatostatin receptor scintigraphy using 99mTc-EDDA/HYNIC-TOC in patients with medullary thyroid carcinoma[J].Eur J Nucl Med Mol Imaging,2007,34(10):1635-1645.
[11]李毅,徐俊彦,许晓平,等.99mTc-HYNIC-TOC SPECT/CT显像探测结直肠神经内分泌肿瘤的临床价值[J].肿瘤影像学,2017,26(1):67-71.
[12]KOOPMANS K P,DE GROOT J W,PLUKKER J T,et al.18F-dihydroxyphenylalanine PET in patients with biochemical evidence of medullary thyroid cancer:relation to tumor differentiation[J].J Nucl Med,2008,49(4):524-531.
[13]IACOBONE M,NICCOLI-SIRE P,SEBAG F,et al.Can sporadic medullary thyroid carcinoma be biochemically predicted?Prospective analysis of 66 operated patients with elevated serum calcitonin levels[J].World J Surg,2002,26(8):886-890.
[14]蒋津津,许晓平,张建平,等.99mTc-HYNIC-TOC小动物SPECT/CT显像和人体内照射剂量估算[J].肿瘤影像学,2013,22(3):231-236.
[15]WELLS S A,SANTORO M.Targeting the RET pathway in thyroid cancer[J].Clin Cancer Res,2009,15(23):7119-7123.
[16]ROY M,CHEN H,SIPPEL R S.Current understanding and management of medullary thyroid cancer[J].Oncologist,2013,18(10):1093-1100.
[17]MACHENSA,DRALLEH.Pretarget edanticar for medullary thyroid carcinoma[J].J Clin Oncol,2006,24(20):e37;author reply e38.
[18]JARZAB B,DEDECJUS M,HANDKIEWICZ-JUNAK D,et al.Diagnostics and treatment of thyroid carcinoma[J].Endokrynol Pol,2016,67(1):74-107.
[19]YA M A M U R A K,S U Z U K I S,YA M A M O TO I.Differentiation of pituitary adenomas from other sellar and parasellar tumors by 99mTc(V)-DMSA scintigraphy[J].Neurol Med Chir(Tokyo),2003,43(4):181-186;discussion187.
[20]TSIOURIS S,PIRMETTIS I,CHATZIPANAGIOTOU T,et al.Pentavalent technetium-99m dimercaptosuccinic acid[99m Tc-(V)DMSA]brain scintitomography—a plausible non-invasive depicter of glioblastoma proliferation and therapy response[J].J Neuro Oncol,2007,85(3):291-295.
[21]BANDOPADHYAYA G P,GUPTA P,SINGH A,et al.99mTcDMSA(V)in evaluation of osteosarcoma:Comparative studies with 18F-FDG PET/CT in detection of primary and malignant lesions[J].ISRN Oncol,2012,2012(10):371830.
[22]CASCINI G L,CUCCURULLO V,MANSI L.The non tumour uptake of 111In-octreotide creates new clinical indications in benign diseases,but also in oncology[J].Q J Nucl Med Mol Imaging,2010,54(1):24-36.
[23]DE GROOT J W,LINKS T P,JAGER P L,et al.Impact of18F-fluoro-2-deoxy-D-glucose positron emission tomography(FDG-PET)in patients with biochemical evidence of recurrent or residual medullary thyroid cancer[J].Ann Surg Oncol,2004,11(8):786-794.
[24]DIEHL M,RISSE J H,BRANDT-MAINZ K,et al.Fluorine-18 fluorod eoxyglucosepositronemission tomography in medullary thyroid cancer:results of a multicentre study[J].Eur J Nucl Med,2001,28(11):1671-1676.
[25]JIANG J,YANG Z,ZHANG Y,et al.Clinical value of[18F]FDG-PET/CT in the detection of metastatic medullary thyroid cancer[J].Clin Imaging,2014,38(6):797-801.
[26]B E L H O C I N E T,F O I D A RT J,R I G O P,e t a l.Fluorodeoxyglucose positron emission tomography and somatostatin receptor scintigraphy for diagnosing and staging carcinoid tumours:correlations with the pathological indexes p53 and Ki-67[J].Nucl Med Commun,2002,23(8):727-734.
[27]UGUR O,KOSTAKGLU L,GULER N,et al.Comparison of 99mTc(V)-DMSA,201Tl and 99mTc-MIBI imaging in the follow-up of patients with medullary carcinoma of the thyroid[J].Eur J Nucl Med,1996,23(10):1367-1371.
[28]BARANAUSKAS Z,VALUCKAS K P,SMAILYTE G.Combined treatment and survival of medullary thyroid carcinoma patients[J].Cent Eur J Med,2010,5(4):426-430.
[29]SCHLUMBERGER M,CARLOMAGNO F,BAUDIN E,et al.New therapeutic approaches to treat medullary thyroid carcinoma[J].Nat Clin Practice Endocrinol Metab,2008,4(1):22-32.
[30]SHUKLA J,MITTAL B R.Dimercaptosuccinic acid:A multifunctional cost effective agent for imaging and therapy[J].Indian J Nucl Med,2015,30(4):295-302.
[31]MOHAMMED A A,EL-SHENTENAWY A.Advanced thyroid cancers:new era of treatment[J].Med Oncol,2014,31(7):1-8.
[32]ROBINSON B G,PAZ-ARES L,KREBS A,et al.Vandetanib(100 mg)in patients with locally advanced or metastatic hereditary medullary thyroid cancer[J].J Clin Endocrinol Metab,2010,95(6):2664-2671.
[33]PAZAITOU-PANAYIOTOU K,TIENSUU JANSON E,KOLETSA T,et al.Somatostatin receptor expression in nonmedullary thyroid carcinomas[J].Hormones(Athens),2012,11(3):290-296.
[34]PERREN A,COUVELARD A,SCOAZEC J Y,et al.ENETS consensus guidelines for the standards of care in neuroendocrine tumors:pathology-diagnosis and prognostic s t r a t i f i c a t i o n[J].N e u r o e n d o c r i n o l o g y,2 0 1 7.d o i:10.1159/000457956.