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 68 Ga-Alfatide II with 18 F-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 68 Ga-Alfatide II or 18 F-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 α v β 3 in NSCLC and TB primary lesions was analyzed by immunohistochemistry. Results: The 68 Ga-Alfatide II SUV max and SUV mean were significantly different in NSCLC and TB (P 5 0.0001 and 0.0007, respectively). The area under the receiver-operating curve value of 68 Ga-Alfatide II SUV max was significantly higher than that of 18 F-FDG (P 5 0.038). The visual differentiation diagnostic specificity of 68 Ga-Alfatide II was 1.57-fold (84.62% vs. 53.85%) higher than that of 18 F-FDG. In the detection of NSCLC lymph nodes, 68 Ga-Alfatide II was superior in specificity (100% vs. 66.7%), whereas the sensitivity was greater with 18 F-FDG (87.5% vs. 75%). In TB lymph node detection, the false-positive rate of 68 Ga-Alfatide II was one-third (15.4%/ 46.2%) the value of 18 F-FDG. Additionally, 68 Ga-Alfatide II detected more metastases in the brain but less in the liver and the bone. The α v β 3 biomarker was specifically expressed in the cells and the neovasculature of NSCLC lesions. Conclusion: 68 Ga-Alfatide II is qualified for detecting NSCLC primary lesions and is superior to 18 F-FDG in distinguishing NSCLC from TB in primary lesions and suggestive lymph nodes. 68 Ga-Alfatide II is more likely to be capable of detecting brain metastasis, and 18 F-FDG is more likely to be capable of detecting liver and early-stage bone metastases.

18F-Alfatide II PET/CT for Identification of Breast Cancer: A Preliminary Clinical Study

“…Second, lymph node and other distant metastases were not evaluated due to the limited number of metastatic lesions in these patients. Third, immunohistochemistry tests were not performed to assess the correlation between integrin a v b 3 expression and alfatide II uptake, which has been demonstrated in several animal and clinical studies (12,16,39). Further investigations are still required in the future to elucidate the role of 18 F-alfatide II in breast cancer management.…”

Combination of Circulating Cell-Free DNA and Metabolic Tumor Burden to Distinguish Non-Small Cell Lung Cancer from Tuberculosis

“…For instance, the SUV-Max a , the value of a single voxel with the highest radiotracer (18F-FDG) concentrations within the tumor, was a indicator of the metabolic tumor burden [16,17]. This study found that SUV-Max a was increased in NSCLC patients compared with that in healthy controls and tuberculosis patients, and could be used for the diagnosis and the differential diagnosis of NSCLC just as a previous report [6]. Of note, although SUV-Max a was useful and might be a surrogate marker of the metabolic tumor burden, it was affected by many factors and was highly sensitive to noise [34,35].…”

18F‑alfatide positron emission tomography may predict anti‑angiogenic responses

“…Intratumor angiogenic heterogeneity (CV) also existed among the groups and was higher in the A549 group than in the PC-3 group. RGD-based tracer targeting of αvβ3 has already been used in the diagnosis of malignant tumors (10,26,27) and in predicting the efficacy of CCRT in NSCLC (13,14). Low 68 Ga-RGD 2 uptake and poor αvβ3 expression in SCLC may have led to the conclusion that αvβ3-targeted therapy is not adequate for the majority of SCLC patients.…”