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Fluorine-18--Methyltyrosine Positron Emission Tomography for Diagnosis and Staging of Lung Cancer: A Clinicopathologic Study

Authors' Affiliations: Departments of ¹ Medicine and Molecular Science, ² Diagnostic Radiology and Nuclear Medicine, ³ Thoracic and Visceral Organ Surgery, ⁴ General Surgical Science, and ⁵ Tumor Pathology, Gunma University Graduate School of Medicine; ⁶ Gunma University School of Health Sciences, Showa-machi, Maebashi, Gunma, Japan; and ⁷ Department of Pharmacology and Toxicology, Kyorin University School of Medicine, Shinkawa, Mitaka, Tokyo, Japan

Requests for reprints: Kyoichi Kaira, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma 371-8511, Japan. Phone: 81-27-220-8136; Fax: 81-27-220-8136; E-mail: kkaira1970{at}yahoo.co.jp.

Purpose: L-[3-¹⁸F]--Methyltyrosine ([¹⁸F]FMT) is an amino acid tracer for positron emission tomography (PET). We evaluated the diagnostic usefulness of [¹⁸F]FMT PET in non–small-cell lung cancer (NSCLC) patients. Tumor uptake of [¹⁸F]FMT was compared with that of 2-[¹⁸F]-fluoro-2-deoxy-D-glucose ([¹⁸F]FDG) and correlated with L-type amino acid transporter 1 (LAT1) expression.

Experimental Design: Fifty NSCLC patients were enrolled in this study, and a pair of PET study with [¹⁸F]FMT and [¹⁸F]FDG was done. LAT1 expression and Ki-67 labeling index of the resected tumors were analyzed by immunohistochemical staining.

Results: For the primary tumor detection, [¹⁸F]FMT PET exhibited a sensitivity of 90% whereas the sensitivity for [¹⁸F]FDG PET was 94%. For lymph node staging, the sensitivity and specificity of [¹⁸F]FMT PET were 57.8% and 100%, and those of [¹⁸F]FDG PET were 65.7% and 91%, respectively. The expression of LAT1 in squamous cell carcinoma and large cell carcinoma was significantly higher than that in adenocarcinoma. [¹⁸F]FMT uptake was also higher in squamous cell carcinoma and large cell carcinoma than in adenocarcinoma. Uptake of [¹⁸F]FMT in the tumor is closely correlated with LAT1 expression ( = 0.890).

Conclusion: [¹⁸F]FMT PET had no false-positives in the detection of primary tumor and lymph node metastasis and could improve the diagnostic performance in NSCLC. Uptake of [¹⁸F]FMT correlated with the expression of LAT1 that showed a significant association with cellular proliferation.

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