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18F-FAZA PET/CT in the Preoperative Evaluation of NSCLC: Comparison with 18F-FDG and Immunohistochemistry

[ Vol. 11 , Issue. 1 ]

Author(s):

Paola Mapelli, Valentino Bettinardi, Federico Fallanca, Elena Incerti, Antonia Compierchio, Francesca Rossetti, Angela Coliva, Annarita Savi, Claudio Doglioni, Giampiero Negri, Luigi Gianolli and Maria Picchio*   Pages 50 - 57 ( 8 )

Abstract:


Purpose: To assess the capability of 18F-FAZA PET/CT in identifying intratumoral hypoxic areas in early and locally advanced non-small cell lung cancer (NSCLC) patients and to compare 18FFAZA PET/CT with 18F-FDG PET/CT and histopathological biomarkers and to investigate whether the assessment of tumour to blood (T/B) and tumour to muscle (T/M) ratios provide comparable information regarding the hypoxic fractions of the tumour.

Materials and Methods: Seven patients with NSCLC were prospectively enrolled (3 men, 4 women; median age: 71 years; range 63-80). All patients underwent to 18F-FDG PET/CT and 18F-FAZA PET/CT before surgery. Maximum standardized uptake value (SUVmax) was used to evaluate 18FFDG PET/CT images, while 18F-FAZA PET/CT images have been interpreted by using tumour-toblood (T/B) and tumour-to-muscle (T/M) ratio. Surgery was performed in all patients; immunohistochemical analysis for hypoxia biomarkers was performed on histologic tumor samples.

Results: All lung lesions showed intense 18F-FDG uptake (mean SUVmax: 7.35; range: 2.35-25.20). A faint 18F-FAZA uptake was observed in 6/7 patients (T/B < 1.2) while significant uptake was present in the remaining 1/7 (T/B and T/M=2.24). On both 2 and 4 h imaging after injection, no differences were observed between T/M and T/B (p=0.5), suggesting that both blood and muscle are equivalent in estimating the background activity for image analysis. Immunohisotchemical analysis showed low or absent staining for hypoxia biomarkers in 3 patients (CA-IX and GLUT-1: 0%; HIF-1α: mean 3.3%; range 0-10). Two patients showed staining for HIF-1α of 5%, with CA-IX being 60% and 30%, respectively and GLUT-1 being 30% and 80%, respectively; in 1/7 HIF-1α was 10%, CA-IX was 50% and GLUT-1 was 90%. In one patient a higher percentage of HIF-1α and CA-IX (20% and 70%, respectively) positive cells was present, with GLUT-1 being 30%.

Conclusions: To the best of our knowledge, this is the first paper assessing hypoxia and glucose metabolism in comparison with immunohistochemistry in patients candidate to surgery for NSCLC. Although including a small number of patients, useful insight regarding correlation between imaging and immunohistochemistry are reported along with methodological suggestions for clinical practice.

Keywords:

18F-FAZA, 18F-FDG, PET/CT, non-small cell lung cancer, hypoxia.

Affiliation:

Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Department of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Vita-Salute San Raffaele University, Milan, Vita-Salute San Raffaele University, Milan, Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan

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