Advantages of 99mTc-CNDG SPECT/CT over Enhanced CT in the Staging of Non-Small Cell Lung Cancer

Abstract Objective To explore the value of 99mTc-isonitrile deoxyglucosamine (CNDG) SPECT/CT in the staging and resectability diagnosis of non-small cell lung cancer (NSCLC) compared with enhanced CT. Methods This research was approved by the hospital ethics review committee. Sixty-three patients with NSCLC received 99mTc-CNDG SPECT/CT, enhanced CT and initial TNM staging before treatment. Thirty-three patients who underwent radical surgery took postoperative pathological TNM staging as the reference standard.Another thirty patients who underwent radiochemotherapy,among them the reference standard of 7 patients of N staging and 5 patients of M staging was based on biopsy pathology，and the diagnosis of the remaining lesions was confirmed by at least one different image or clinical imaging follow-up for more than 3 months. The McNemar test and receiver operating characteristic (ROC) curve analysis were used to compare the diagnostic accuracy of staging and resectability of 99mTc-CNDG SPECT/CT and enhanced CT in NSCLC，respectively. Results For all patients and surgical patients, the accuracies of 99mTc-CNDG SPECT/CT in diagnosing the T stage and N stage were higher than those of enhanced CT (all patients: 90.5%, 88.9% vs. 79.4%, 60.3%; surgical patients: 81.8%, 78.8% vs. 60.6%, 51.5%),and the differences were statistically significant (all patients: T stage, P=0.016; N stage, P =0.000; surgical patients: T stage, P =0.016; N stage, P =0.004). For all patients，the accuracy of 99mTc-CNDG SPECT/CT in diagnosing the M stage was higher than that of enhanced CT(96.8% vs. 90.5%), but the difference was not statistically significant (P =0.289).ROC curve analysis showed that the accuracy of 99mTc-CNDG SPECT/CT in diagnosing the potential resectability of NSCLC was significantly better than that of enhanced CT(P=0.046). Conclusion This preliminary clinical study shows that 99mTc-CNDG SPECT/CT is of great value for accurate clinical staging of NSCLC compared with enhanced CT, and can significantly improve the accuracy of resectability diagnosis.