The use of 99mTc-ciprofloxacin (Infecton) scintigraphy in detection of cervical lymphadenitis

Background: Cervical lymphadenitis maybe caused by bacterial infection or non- bacterial inflammation. 99mTc-labeled ciprofloxacin (Infecton) has been developed for detecting infection foci. 99mTc- Infecton will be accumulated in the DNA gyrase of living bacteria. The aim of this study is to determine sensitivity and specificity of 99mTc-ciprofloxacin scintigraphy in detecting cervical lymphadenitis in patients with cervical lymphadenopathy. Material and Method: The subjects were twenty-three patients, six men and seventeen women with cervical lymphadenopathy, age ranging from 15-68 years (mean 34.2+10.9) referred to our department, during the period of February-April 2001. All patients underwent histopathologic examination by open biopsy. Imagings were obtained at 1 and 4 hours after iv injection of 370 MBq (10 mCi) 99mTc-Infecton, 700 kcount/image, AP/oblique position. ROIs were drawn over suspected lymph node(s) and surrounding soft tissue as background. Image interpretation was made based on target to background (T/B) ratio. Positive imaging if T/B ratio (cut of point)>/= 1.2 Results: Positive imagings were observed in 16 and negative in 7 subjects. The results of histopathologic examination were infection (tuberculous lymphadenitis/chronic non-specific infection) in 17 subjects and non-infection/tumor metastases in 6 subjects. One of 16 subjects with positive imaging had histopathologic examination of tumor metastases. Two of 7 subjects with negative imagings had histopathologic results of tuberculous infection and one them had been treated with antibiotic (amoxicillin). Based on scintigraphy results, it was found; true positive in 15 subjects, false positive in 1 subject, true negative in 5 subjects and false negative in 2 subject. Sensitivity, specificity, positive predictive values and negative predictive value were 93%, 71%, 88%, 83% respectively. Conclusion: Infecton scintigraphy is specific diagnostic tool for infection and it can be used in detecting bacterial lymphadenitis. (authors)