Comparing the diagnostic potential of 68Ga-Alfatide II and 18F-FDG in differentiating between non small cell lung cancer and tuberculosis

Abstract

The objectives of this study were to compare the diagnostic potential of 68Ga-Alfatide II with18F-FDG in differentiating between non small cell lung cancer patients (NSCLC) and lung tuberculosis (TB) patients. Methods: Twenty-one NSCLC patients and 13 TB patients were recruited. PET/CT images using either 68Ga-Alfatide II or 18F-FDG were acquired in 2 consecutive days. SUV quantitative comparison, receiver-operating curve analysis, and comprehensive visual analysis were performed. The expression of the angiogenesis marker αvβ3 in NSCLC and TB primary lesions was analyzed by immunohistochemistry. Results: The 68Ga-Alfatide II SUVmax and SUVmean were significantly different in NSCLC and TB (P 5 0.0001 and 0.0007, respectively). The area under the receiver-operating curve value of 68Ga-Alfatide II SUVmax was significantly higher than that of 18F-FDG (P 5 0.038). The visual differentiation diagnostic specificity of 68Ga-Alfatide II was 1.57-fold (84.62% vs. 53.85%) higher than that of 18F-FDG. In the detection of NSCLC lymph nodes, 68Ga-Alfatide II was superior in specificity (100% vs. 66.7%), whereas the sensitivity was greater with 18F-FDG (87.5% vs. 75%). In TB lymph node detection, the false-positive rate of 68Ga-Alfatide II was one-third (15.4%/ 46.2%) the value of 18F-FDG. Additionally, 68Ga-Alfatide II detected more metastases in the brain but less in the liver and the bone. The αvβ3 biomarker was specifically expressed in the cells and the neovasculature of NSCLC lesions. Conclusion: 68Ga-Alfatide II is qualified for detecting NSCLC primary lesions and is superior to 18F-FDG in distinguishing NSCLC from TB in primary lesions and suggestive lymph nodes. 68Ga-Alfatide II is more likely to be capable of detecting brain metastasis, and 18F-FDG ismore likely to be capable of detecting liver and early-stage bone metastases. 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc.