99mTc-HYNIC-rh-annexin-V scintigraphy: visual and quantitative evaluation of early treatment-induced apoptosis to predict treatment outcome.
OBJECTIVE
To determine the reliability of visual analysis of 99mTc-HYNIC-rh-annexin-V tumour uptake (ATU) compared to quantitative tracer uptake evaluation.


METHODS
Thirty-eight patients (22 male, 16 female, mean age 57) with histologically proved lymphoma (n=31), non-small cell lung cancer (NSCLC) (n=4) and head and neck squamous cell carcinoma (H&NSCC) (n=3) were examined. 99mTc-HYNIC-rh-annexin-V scintigraphy (TAS) was acquired before and within 2 days after the start of anti-cancer treatment. Maximal counts per pixel in the tumour volume (Cmax) were calculated for every target lesion. To match the quantitative and visual ATU, both were expressed as a four-grade score. Cmax as percentages of baseline values: grade 1, decrease >25%; grade 0, 1-25% decrease; grade 1, 1-25% increase; grade 2, >25% increase. Visual analysis: 0=absent, 1=weak, 2=moderate, 3=intense. Intra-observer and inter-observer variability and methodological agreement between visual and quantitative evaluation of ATU was expressed by computing Cohen's kappa statistics.


RESULTS
A statistically highly significant correlation was found between the changes in ATU and therapy outcome: r=0.97 (P<0.0001) and r=0.99 (P<0.0001) for visual and quantitative analysis, respectively. Good intra-observer reproducibility, with a high kappa of 0.82 for observer 1 and a kappa of 0.90 for observer 2, was determined. Inter-observer variability was 0.82.


CONCLUSIONS
Visual evaluation of ATU after image co-registration appears to be a reliable and reproducible method for preliminary assessment of early treatment-induced apoptosis.
Department of Nuclear Medicine, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Marina S
MS
Kartachova
Renato A
RA
Valdés Olmos
Rick L M
RL
Haas
Frank J P
FJ
Hoebers
Marcel
M
van Herk
Marcel
M
Verheij
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017304:Annexin A5 / Q000493:pharmacokinetics; D017209:Apoptosis; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism / Q000628:therapy; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D015609:Organotechnetium Compounds / Q000493:pharmacokinetics; D011379:Prognosis; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D017304:Annexin A5; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C117287:technetium Tc 99m HYNIC annexin V