Mankoff D A, Dunnwald L K, Gralow J R, Ellis G K, Drucker M J, Livingston R B
Division of Nuclear Medicine, University of Washington, Seattle, USA.
Cancer. 1999 Jun 1;85(11):2410-23.
Mammographic and physical examination assessments of the response of locally advanced breast carcinoma (LABC) to neoadjuvant therapy have been shown to be inaccurate. The authors studied the feasibility and accuracy of [technetium 99m]-sestamibi (MIBI) for monitoring the response of patients with LABC to neoadjuvant chemotherapy.
Patients receiving neoadjuvant chemotherapy for LABC underwent prone lateral scintimammography before therapy, after 2 months of therapy, and close to the completion of chemotherapy (presurgery) if chemotherapy continued for >3 months. Images were analyzed both qualitatively and quantitatively using the lesion-to-normal breast MIBI uptake ratio (L:N). Imaging results were compared with the clinical response and the pathologic response as determined from the posttherapy surgical specimen.
A total of 32 patients (29 who were assessable for primary tumor response and 28 who were assessable for lymph node response) were included in the study. The mean change in the primary tumor L:N MIBI uptake ratio after 2 months of chemotherapy was -35% for clinical responders and +17% for nonresponders (P<0.001). Patients achieving a pathologic primary tumor macroscopic complete response (CR) had a mean change in uptake on the presurgical scan of -58% versus -18% for patients with a partial response (P<0.005). A decrease of > or =40% in the MIBI uptake ratio identified CRs with 100% sensitivity and 89% specificity. Pretherapy imaging predicted axillary lymph node metastases in 85% of patients ultimately found to have > or =1 positive lymph nodes at surgery, but was less accurate in identifying residual lymph node disease after therapy (55% sensitivity and 75% specificity).
MIBI imaging accurately assessed the response to neoadjuvant chemotherapy in patients with LABC. Further studies are needed to determine the role of MIBI in this group of patients.
乳腺钼靶检查和体格检查对局部晚期乳腺癌（LABC）新辅助治疗反应的评估已被证明不准确。作者研究了[锝99m] - 甲氧基异丁基异腈（MIBI）监测LABC患者新辅助化疗反应的可行性和准确性。
接受LABC新辅助化疗的患者在治疗前、治疗2个月后以及如果化疗持续超过3个月则在化疗接近完成时（术前）进行俯卧位侧位乳腺闪烁显像。使用病变与正常乳腺的MIBI摄取比值（L:N）对图像进行定性和定量分析。将成像结果与临床反应以及治疗后手术标本确定的病理反应进行比较。
共有32例患者（29例可评估原发肿瘤反应，28例可评估淋巴结反应）纳入研究。化疗2个月后，临床反应者原发肿瘤L:N MIBI摄取比值的平均变化为-35%，无反应者为+17%（P<0.001）。达到病理原发肿瘤宏观完全缓解（CR）的患者术前扫描摄取的平均变化为-58%，部分缓解患者为-18%（P<0.005）。MIBI摄取比值下降≥40%可100%敏感且89%特异的识别CR。治疗前成像预测85%最终手术发现有≥1个阳性淋巴结的患者有腋窝淋巴结转移，但在识别治疗后残留淋巴结疾病方面准确性较低（敏感性55%，特异性75%）。
MIBI成像准确评估了LABC患者对新辅助化疗的反应。需要进一步研究以确定MIBI在这组患者中的作用。
