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Assessment of tumour necrosis and detection of mediastinal lymph node metastasis in bronchial carcinoma with technetium-99m sestamibi imaging: comparison with CT scan

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Abstract

Thirty-eight patients with four major types of bronchial carcinoma were studied to evaluate technetium-99m sestamibi imaging in the assessment of tumour necrosis and the detection of hilar and mediastinal lymph node metastasis. Quantitative analysis was also performed to ascertain whether tumour uptake values correlate with histological types of bronchial carcinoma. Of the patients, 34 showed tumour uptake on planar imaging (n = 38) and 27 on single-photon emission tomography (SPET) (n = 29), the overall sensitivity in the localisation of primary tumour being 89% with planar imaging and 93% with SPET. Four types of tumour uptake pattern were identified: (1) focal uptake, (2) focal uptake with a central hypoactive focus, (3) ring-like uptake and (4) no uptake (negative uptake). Tumour necrosis was diagnosed in 12 patients based upon histopathology (n = 2) and density measurements and type of contrast enhancement on computed tomography (CT) scan (n = 12). Defective tumour uptake was seen in 11 of these patients on planar images (focal uptake with a central hypoactive focus, n = 7; ring-like uptake, n = 2; and no tumour uptake, n = 2) and in 12 patients on SPET (focal uptake with a central hypoactive focus, n = 7, ring-like uptake, n = 3, and no uptake, n = 2). Hilar and mediastinal lymph node involvement was detected in ten patients on CT scan, nine on planar images and 11 on SPET. A total of 26 metastatic lymph nodes were detected on CT scan; 24 of these were seen on planar, and all 26 on SPET images. SPET disclosed five further lymph nodes with metastasis, all of which were confirmed by histopathological examination of the surgical material (n = 3). The sensitivity in establishing the hilar and mediastinal disease was 90% on planar images, and 100% on SPET slices, but when the number of lymph nodes was taken into account, these values were 62% and 100%, respectively. Also, brain metastases were detected with SPET in three patients. The results of quantitative analysis of tumour uptake did not differentiate between squamous cell carcinoma and adenocarcinoma. We conclude that 99mTc-sestamibi, particularly with SPET imaging, is potentially useful in the follow-up of patients with bronchial carcinoma by differentiating residual or recurrent disease from postradiotherapy necrosis, and is as sensitive as CT scan in the detection of hilar and mediastinal lymph node metastasis.

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Author notes

  1. Cumali Aktolun

    Present address: Nuclear Medicine Unit, Department of Diagnostic Radiology, Hammersmith Hospital, Royal Postgraduate Medical School, Du Cane Road, W12 OHS, London, UK

Authors and Affiliations

  1. Department of Nuclear Medicine, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey

    Cumali Aktolun & Hikmet Bayhan

  2. Department of Diagnostic Radiology, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey

    Yuksel Pabuccu

  3. Department of Chest Diseases, School of Medicine, Gulhane Military Medical Academy, Ankara, Turkey

    Hayati Bilgic, Huseyin Acar & Ramazan Koylu

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  1. Cumali Aktolun
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  2. Hikmet Bayhan
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  4. Hayati Bilgic
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  5. Huseyin Acar
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  6. Ramazan Koylu
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Aktolun, C., Bayhan, H., Pabuccu, Y. et al. Assessment of tumour necrosis and detection of mediastinal lymph node metastasis in bronchial carcinoma with technetium-99m sestamibi imaging: comparison with CT scan. Eur J Nucl Med 21, 973–979 (1994). https://doi.org/10.1007/BF00238122

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  • DOI: https://doi.org/10.1007/BF00238122

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