Chest
Volume 102, Issue 2, August 1992, Pages 530-534
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Clinical Investigations
Relationship between Gallium 67 Citrate Scanning and Transferrin Receptor Expression in Lung Diseases

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The uptake of gallium 67 (67Ga) into cells is postulated to be through transferrin receptors (TFR) of 67Ga combined with transferrin. We studied the relationship between gallium 67 citrate scanning (67Ga scan) and immunohistochemical TFR expression in lungs of nine patients with lung cancer and eight patients with diffuse interstitial lung diseases. We found that lung cancer tissues of positive 67Ga scan expressed TFR, but those of a negative scan did not. In all of the five patients with idiopathic pulmonary fibrosis (IPF), TFR were expressed on the membrane of alveolar macrophages that formed clusters. However, TFR were not expressed in lymphocytes, neutrophils, type 2 alveolar epithelial cells, and endothelial cells. In two patients with sarcoidosis and a patient with pneumoconiosis, TFR were expressed positively only on the membrane of foamy alveolar macrophages and epithelioid cells of granuloma. These findings suggest that 67Ga-citrate initially combines with transferrin in the blood and then the complex is incorporated into cells through TFR. Therefore, 67Ga scan could be positive when cells have TFR and one should be able to observe cancer cells, clusters of alveolar macrophages, and epithelioid cells through the imaging of 67Ga scan in lung cancer and diffuse interstitial lung diseases.

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Patients

Nine patients with lung cancer who underwent 67Ga scan and operation were studied. Four of them were positive for 67Ga scan and five were negative. Eight patients with histologically proven diffuse interstitial lung disease (five IPF, two sarcoidosis, and one pneumoconiosis) were also studied with 67Ga scan (Table 1). Histologically normal tissues obtained from four nonsmoker patients who underwent operation for lung cancer were also investigated.

67Ga Citrate Scanning

67Ga is a cyclotron-produced radionuclide with a

RESULTS

In normal lung tissues, bronchoalveolar epithelial cells, bronchial glands, vascular endothelial cells, and other interstitial cells were negative for TFR. Only alveolar macrophage observed scarcely in alveolar spaces of normal lung tissues showed mildly positive TFR staining on its membrane, but no clusters of alveolar macrophages were observed. All lung cancer tissue specimens from four patients with lung cancer who were positive for 67Ga scan showed strong positive TFR staining on the

DISCUSSION

67Ga scan has been used as a tumor scintigram to detect lung cancer and as an indicator of active diffuse interstitial lung diseases. First, the present study demonstrated that TFR were strongly expressed on lung cancer tissues of all 67Ga scan-positive patients, but TFR were not expressed on those of 67Ga scan-negative patients. These results suggest uptake of 67Ga combined with transferrin by cancer cells whose membranes express TFR.

It has been reported that 85 to 95 percent of lung cancers

ACKNOWLEDGMENTS

The writers thank Professor Hidehiko Saito, First Department of Internal Medicine, Nagoya University School of Medicine, and Dr. Tatsunari Satake, Pathology section, Nagoya Ekisaikai Hospital, for their valuable suggestions and comments.

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    Manuscript received June 14; revision accepted November 26.

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