Schirrmeister H, Kühn T, Guhlmann A, Santjohanser C, Hörster T, Nüssle K, Koretz K, Glatting G, Rieber A, Kreienberg R, Buck A C, Reske S N
Department of Nuclear Medicine, University Hospital, 89070 Ulm, Germany.
Eur J Nucl Med. 2001 Mar;28(3):351-8. doi: 10.1007/s002590000448.
The present study compared the diagnostic accuracy of fluorine-18 2-deoxy-2-fluoro-D-glucose positron emission tomography (FDG-PET) with conventional staging techniques. The differentiation between malignant and benign lesions and the detection of multifocal disease, axillary and internal lymph node involvement, and distant metastases were evaluated. One hundred and seventeen female patients were prospectively examined using FDG-PET and conventional staging methods such as chest X-ray, ultrasonography of the breast and liver, mammography and bone scintigraphy. All patients were examined on a modern full-ring PET scanner. Histopathological analysis of resected specimens was employed as the reference method. The readers of FDG-PET were blinded to the results of the other imaging methods and to the site of the breast tumour. The sensitivity and specificity of FDG-PET in detecting malignant breast lesions were 93% and 75% respectively. FDG-PET was twofold more sensitive (sensitivity 63%, specificity 95%) in detecting multifocal lesions than the combination of mammography and ultrasonography (sensitivity 32%, specificity 93%). Sensitivity and specificity of FDG-PET in detecting axillary lymph node metastases were 79% and 92% (41% and 96% for clinical evaluation). FDG-PET correctly indicated distant metastases in seven patients. False-positive or false-negative findings were not encountered with FDG-PET. Chest X-ray was false-negative in three of five patients with lung metastases. Bone scintigraphy was false-positive in four patients. Three patients were upstaged since FDG-PET detected distant metastases missed with the standard staging procedure. It is concluded that, compared with the imaging methods currently employed for initial staging, FDG-PET is as accurate in interpreting the primary tumour and more accurate in screening for lymph node metastases and distant metastases. Due to a false-negative rate of 20% in detecting axillary lymph node metastases, FDG-PET cannot replace histological evaluation of axillary status.
本研究比较了氟 - 18 2 - 脱氧 - 2 - 氟 - D - 葡萄糖正电子发射断层扫描（FDG - PET）与传统分期技术的诊断准确性。评估了恶性和良性病变的鉴别以及多灶性疾病、腋窝和内淋巴结受累及远处转移的检测情况。对117例女性患者前瞻性地采用FDG - PET及传统分期方法进行检查，如胸部X线、乳腺和肝脏超声检查、乳腺钼靶摄影及骨闪烁显像。所有患者均在现代全环PET扫描仪上进行检查。采用切除标本的组织病理学分析作为参考方法。FDG - PET的阅片者对其他影像学检查结果及乳腺肿瘤部位不知情。FDG - PET检测恶性乳腺病变的敏感性和特异性分别为93%和75%。FDG - PET在检测多灶性病变方面的敏感性（63%）是乳腺钼靶摄影和超声检查联合应用（敏感性32%）的两倍，特异性为95%（联合应用特异性为93%）。FDG - PET检测腋窝淋巴结转移的敏感性和特异性分别为79%和92%（临床评估的敏感性和特异性分别为41%和96%）。FDG - PET正确显示了7例患者的远处转移。FDG - PET未出现假阳性或假阴性结果。5例肺转移患者中有3例胸部X线检查结果为假阴性。骨闪烁显像有4例假阳性。3例患者因FDG - PET检测到标准分期程序遗漏的远处转移而被重新分期。结论是，与目前用于初始分期的影像学方法相比，FDG - PET在解释原发性肿瘤方面同样准确，在筛查淋巴结转移和远处转移方面更准确。由于在检测腋窝淋巴结转移方面有20%的假阴性率，FDG - PET不能替代腋窝状态的组织学评估。
