Role of [99mTc]Tc-Galacto-RGD2 SPECT/CT in identifying metastatic differentiated thyroid carcinoma after thyroidectomy and radioactive iodine therapy

Xu, Qinfeng; Liu, Rencong; Wang, Jun; Huang, Yue; Li, Shaohua; Zhang, Lele; Wang, Feng

doi:10.1016/j.nucmedbio.2020.06.006

Cited by 5 publications

(8 citation statements)

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“…Selecting TKI-sensitive patients thus remains a challenge, highlighting the need for alternative (preferably noninvasive) means of patient selection. We previously validated the ability of 99m Tc-Galacto-RGD 2 to identify iodine-refractory status in patients with thyroid cancer [36]. In a rare case with a solitary brous tumour located in the main pulmonary artery, 99m Tc-Galacto-RGD 2 imaging played an important role in detecting the primary tumour and predicting the metastatic potential [27].…”

Section: Discussionmentioning

confidence: 93%

99mTc-Galacto-RGD2 Integrin αvβ3 Targeted Imaging as a Surrogate for Molecular Phenotyping in Lung Cancer: Prospective Study in the Real World

Fu¹,

Yan²,

Fu³

et al. 2021

Preprint

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Purpose: Epidermal growth factor receptor tyrosine kinase inhibitors (TKIs) are beneficial in patients with lung cancer. We explored the clinical value of 99mTc-Galacto-RGD2 single-photon emission computed tomography (SPECT/CT) in patients with lung cancer, Integrin αvβ3 expression, and neovascularization in lung cancer subtypes was also addressed. Methods: A total of 185 patients with lung cancer and 25 patients with benign lung diseases were enrolled in this prostective study from January 2013 to December 2016. All patients underwent 99mTc-Galacto-RGD2 imaging. The region of interest was drawn around each primary lesion, and tumour uptake of 99mTc-Galacto-RGD2 was measured as the tumour/normal tissue ratio（T/N）. The diagnostic efficacy was evaluated by receiver operating characteristic curve analysis. Tumour tissues were obtained from 66 patients with malignant diseases and seven with benign disease. Tumour expression levels of αvβ3, CD31, Ki-67, and CXCR4 were analysed to determine their value for phenotyping and metastasis potential evaluation. Results: The lung cancer patients included 22 cases of small cell lung cancer (SCLC), 48 squamous cell carcinoma (LSC), 97 adenocarcinoma (LAC), and 18 other types of lung cancer. The sensitivity, specificity, and accuracy of 99mTc-Galacto-RGD2 SPECT/CT using a cut-off value of 2.5 were 91.89 %, 48.0 %, and 86.67 %, respectively. Integrin αvβ3 expression was higher in non-SCLC compared with SCLC, while LSC showed denser neovascularization and higher integrin αvβ3 expression. Integrin αvβ3 expression levels were significantly higher in advanced (Ⅲ, Ⅳ) than early stages (Ⅰ, Ⅱ). However, there was no significant correlation between tumour uptake and αvβ3 expression. Conclusion: 99mTc-Galacto-RGD2 SPECT/CT has high sensitivity but limited specificity for detecting primary lung cancer. RGD imaging may help evaluate the biological behaviour and phenotyping, and thus aid management in lung cancer.

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Section: Discussionmentioning

confidence: 93%

99mTc-Galacto-RGD2 Integrin αvβ3 Targeted Imaging as a Surrogate for Molecular Phenotyping in Lung Cancer: Prospective Study in the Real World

Fu¹,

Yan²,

Fu³

et al. 2021

Preprint

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“…RGD-peptide based SPECT/CT is a neo-angiogenesis imaging modality which has high affinity and specificity towards integrin α v β 3 . Xu et al reported that 99m Tc-Galacto-RGD 2 SPECT/CT had higher sensitivity than 131 I WBS and morphological imaging in the detection of lymphatic and bone metastasis in DTC patients [ 7 ]. The overall sensitivity and specificity of 99m Tc-Galacto-RGD 2 SPECT/CT were 92.86 and 86.36%, respectively, in the detection of metastatic DTC diseases.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, further survival analysis revealed a trend towards worse PFS in patients with higher than median values for T/B ratio and SUV max . Recent studies reported the T/B ratios of 99m Tc-3PRGD 2 in metastatic DTC lesions were positively correlated with growth rates of these lesions [ 14 ] and patients’ clinical stages [ 7 ]. Another study demonstrated that the SUV max of RAIR-DTC lesions on 68 Ga-DOTA-RGD 2 PET/CT had a strong positive correlation with serum TSH-stimulated Tg levels, which reflecting the disease burden [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…The 99m Tc-3PRGD 2 images were independently reviewed by 2 experienced nuclear medicine physicians who were blinded to the source, history and pathologic conditions of the patients. A positive lesion was defined as the uptake of radiotracer above its background, excluding physiologic uptake [ 7 , 15 ]. Disease foci were divided into the following regions: thyroid bed (remnant/recurrent), nodal disease (cervical or mediastinal) and lung lesions.…”

Section: Methodsmentioning

confidence: 99%

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Evaluation of integrin αvβ3-targeted imaging for predicting disease progression in patients with high-risk differentiated thyroid cancer (using 99mTc-3PRGD2)

et al. 2022

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Background High-risk differentiated thyroid cancer (DTC) needs effective early prediction tools to improving clinical management and prognosis. This cohort study aimed to investigate the prognostic impact of 99mTc-PEG4-E[PEG4-c(RGDfK)]2 (99mTc-3PRGD2) SPECT/CT in high-risk DTC patients after initial radioactive iodine (RAI) therapy. Methods Thirty-three patients with high-risk DTC were prospectively recruited; all patients underwent total thyroidectomy and received 99mTc-3PRGD2 SPECT/CT before RAI ablation. Follow-up was done with serological and imaging studies. The correlation between 99mTc-3PRGD2 avidity and remission rate for initial RAI therapy was evaluated using logistic regression analysis. The prognostic value of 99mTc-3PRGD2 SPECT/CT was evaluated by Kaplan-Meier curve and Cox regression analysis. Results 99mTc-3PRGD2 avidity was significantly correlated with the efficacy of initial RAI ablation and an effective predictor for non-remission in high-risk DTC (OR = 9.36; 95% CI = 1.10–79.83; P = 0.041). 99mTc-3PRGD2 avidity was associated with poor prognosis in patients with high-risk DTC and an independent prognostic factor for shorter progression-free survival (PFS) (HR = 9.47; 95% CI = 1.08–83.20; P = 0.043). Survival analysis, which was performed between DTC patients with concordant (131I positive/99mTc-3PRGD2 positive) and discordant (131I negative/99mTc-3PRGD2 positive) lesions, indicated that patients with concordant lesions had significantly better PFS than those with discordant lesions (P = 0.022). Moreover, compared with repeated RAI, additional surgery or targeted therapy with multikinase inhibitors could lead to a higher rate of remission in 99mTc-3PRGD2-positive patients with progressive disease. Conclusions 99mTc-3PRGD2 SPECT/CT is a useful modality in predicting progression of the disease after initial RAI and guiding further treatment in high-risk DTC patients.

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“…We previously validated the ability of [ 99m Tc]Tc-Galacto-RGD 2 to identify iodine-refractory status in patients with thyroid cancer [ 27 ]. In a rare case with a solitary fibrous tumour located in the main pulmonary artery, [ 99m Tc]Tc-Galacto-RGD 2 imaging played an important role in detecting the primary tumour and predicting the metastatic potential [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

[99mTc]Tc-Galacto-RGD2 integrin αvβ3-targeted imaging as a surrogate for molecular phenotyping in lung cancer: real-world data

Xie

et al. 2021

EJNMMI Res

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Background Epidermal growth factor receptor tyrosine kinase inhibitors (TKIs) are beneficial in patients with lung cancer. We explored the clinical value of [99mTc]Tc-Galacto-RGD2 single-photon emission computed tomography (SPECT/CT) in patients with lung cancer, integrin αvβ3 expression, and neovascularization in lung cancer subtypes was also addressed. Methods A total of 185 patients with lung cancer and 25 patients with benign lung diseases were enrolled in this prospective study from January 2013 to December 2016. All patients underwent [99mTc]Tc-Galacto-RGD2 imaging. The region of interest was drawn around each primary lesion, and tumour uptake of [99mTc]Tc-Galacto-RGD2 was expressed as the tumour/normal tissue ratio(T/N). The diagnostic efficacy was evaluated by receiver operating characteristic curve analysis. Tumour specimens were obtained from 66 patients with malignant diseases and 7 with benign disease. Tumour expression levels of αvβ3, CD31, Ki-67, and CXCR4 were further analysed for the evaluation of biological behaviours. Results The lung cancer patients included 22 cases of small cell lung cancer (SCLC), 48 squamous cell carcinoma (LSC), 97 adenocarcinoma (LAC), and 18 other types of lung cancer. The sensitivity, specificity, and accuracy of [99mTc]Tc-Galacto-RGD2 SPECT/CT using a cut-off value of T/N ratio at 2.5 were 91.89%, 48.0%, and 86.67%, respectively. Integrin αvβ3 expression was higher in non-SCLC compared with SCLC, while LSC showed denser neovascularization and higher integrin αvβ3 expression. Integrin αvβ3 expression levels were significantly higher in advanced (III, IV) than early stages (I, II). However, there was no significant correlation between tumour uptake and αvβ3 expression. Conclusions [99mTc]Tc-Galacto-RGD2 SPECT/CT has high sensitivity but limited specificity for detecting primary lung cancer, integrin expression in the tumour vessel and tumour cell membrane contributes to the tumour uptake.

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Role of [99mTc]Tc-Galacto-RGD2 SPECT/CT in identifying metastatic differentiated thyroid carcinoma after thyroidectomy and radioactive iodine therapy

Cited by 5 publications

References 31 publications

99mTc-Galacto-RGD2 Integrin αvβ3 Targeted Imaging as a Surrogate for Molecular Phenotyping in Lung Cancer: Prospective Study in the Real World

99mTc-Galacto-RGD2 Integrin αvβ3 Targeted Imaging as a Surrogate for Molecular Phenotyping in Lung Cancer: Prospective Study in the Real World

Evaluation of integrin αvβ3-targeted imaging for predicting disease progression in patients with high-risk differentiated thyroid cancer (using 99mTc-3PRGD2)

[99mTc]Tc-Galacto-RGD2 integrin αvβ3-targeted imaging as a surrogate for molecular phenotyping in lung cancer: real-world data

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