Comparing the Diagnostic Potential of ⁶⁸Ga-Alfatide II and ¹⁸F-FDG in Differentiating Between Non–Small Cell Lung Cancer and Tuberculosis

Abstract

UNLABELLED: 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 αvβ3 in NSCLC and TB primary lesions was analyzed by immunohistochemistry. RESULTS: The (68)Ga-Alfatide II SUVmax and SUVmean were significantly different in NSCLC and TB (P = 0.0001 and 0.0007, respectively). The area under the receiver-operating curve value of (68)Ga-Alfatide II SUVmax was significantly higher than that of (18)F-FDG (P = 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 αvβ3 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.