Gallowitsch Hans-Jürgen, Kresnik Ewald, Gasser Johann, Kumnig Gerhild, Igerc Isabel, Mikosch Peter, Lind Peter
Department of Nuclear Medicine and Endocrinology, PET Center, State Hospital Klagenfurt, Austria.
Invest Radiol. 2003 May;38(5):250-6. doi: 10.1097/01.RLI.0000063983.86229.f2.
To evaluate the role of F-18-fluorodeoxyglucose positron-emission tomography (F-18 FDG PET) in the follow-up of breast carcinoma in case of clinical suspicion of local recurrence or distant metastases and/or tumor marker increase in correlation to conventional imaging.
Retrospective analysis of the results of F-18 FDG PET (ECAT ART(R), Siemens CTI MS) of 62 patients (age 58.5 +/- 12.8) with surgically resected breast carcinoma (time interval after surgery, 86 +/- 82 months, mean follow-up 24 +/- 12.6 months). Patient- and lesion-based comparison with conventional imaging (CI) including mammography (MG), ultrasonography (US), computerized tomography (CT), magnetic resonance imaging (MRI), radiography (XR) and bone scintigraphy (BS). Furthermore, we evaluated the influence on tumor stage and therapeutic strategy. A visual qualitative evaluation of lesions was performed.
On a patient base, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for detecting local recurrence or distant metastases were calculated to be 97%, 82%, 87%, 96% and 90% compared with 84%, 60%, 73%, 75% and 74% with CI. On a lesion base, significantly more lymph node (84 vs. 23, P < 0.05) and fewer bone metastases (61 vs. 97, P < 0.05) could be detected by using F-18 FDG PET compared with CI. Sclerotic bone lesions were predominantly detected by BS. On the other hand, there were several patients with more FDG positive bone lesions and also mixed FDG positive/Tc-99m methylenediphosphonate (MDP) negative and FDG negative/Tc-99m MDP positive metastases. In case of normal tumor markers, sensitivity, specificity, PPV, NPV and accuracy for detecting local recurrence or distant metastases were calculated to be 100%, 85.0%, 78.6%, 100% and 90.3% for FDG PET and 80%, 50%, 50%, 80% and 61.5% for CI. An upstaging could be observed in 9.7% (6/62) and downstaging in 12.9% (8/62), leading to a change in therapeutic regimen in 13 patients (21%).
F-18 FDG PET demonstrates apparent advantages in the diagnosis of metastases in patients with breast carcinoma, compared with conventional imaging on a patient base. On a lesion base, significantly more lymph node and less bone metastases can be detected by using F-18 FDG PET compared with conventional imaging, including bone scintigraphy. In patients with clinical suspicion but negative tumor marker profile, too, F-18 FDG PET seems to be a reliable imaging tool for detection of tumor recurrence or metastases. Considering the high predictive value of F-18 FDG PET, tumor stage and therapeutic strategy will be reconsidered in several patients.
评估F-18-氟脱氧葡萄糖正电子发射断层扫描（F-18 FDG PET）在临床怀疑乳腺癌局部复发或远处转移和/或肿瘤标志物升高情况下与传统影像学检查相关的随访中的作用。
回顾性分析62例（年龄58.5±12.8岁）手术切除乳腺癌患者（术后时间间隔86±82个月，平均随访24±12.6个月）的F-18 FDG PET（ECAT ART(R)，西门子CTI MS）结果。基于患者和病灶与包括乳腺X线摄影（MG）、超声检查（US）、计算机断层扫描（CT）、磁共振成像（MRI）、X线摄影（XR）和骨闪烁显像（BS）在内的传统影像学检查（CI）进行比较。此外，我们评估了其对肿瘤分期和治疗策略的影响。对病灶进行视觉定性评估。
在基于患者的情况下，F-18 FDG PET检测局部复发或远处转移的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和准确性分别计算为97%、82%、87%、96%和90%，而CI分别为84%、60%、73%、75%和74%。在基于病灶的情况下，与CI相比，使用F-18 FDG PET可检测到明显更多的淋巴结转移（84个对23个，P<0.05）和更少的骨转移（61个对97个，P<0.05）。硬化性骨病变主要由BS检测到。另一方面，有几例患者存在更多的FDG阳性骨病变，也有混合的FDG阳性/锝-99m亚甲基二膦酸盐（MDP）阴性和FDG阴性/锝-99m MDP阳性转移灶。在肿瘤标志物正常的情况下，F-18 FDG PET检测局部复发或远处转移的敏感性、特异性、PPV、NPV和准确性分别计算为100%、85.0%、78.6%、100%和90.3%，CI分别为80%、50%、50%、80%和61.5%。观察到9.7%（6/62）的患者分期上调，12.9%（8/62）的患者分期下调，导致13例患者（21%）的治疗方案改变。
与基于患者的传统影像学检查相比，F-18 FDG PET在乳腺癌转移诊断中显示出明显优势。在基于病灶的情况下，与包括骨闪烁显像在内的传统影像学检查相比，使用F-18 FDG PET可检测到明显更多的淋巴结转移和更少的骨转移。在临床怀疑但肿瘤标志物检查结果为阴性的患者中F-18 FDG PET似乎也是检测肿瘤复发或转移的可靠影像学工具。考虑到F-18 FDG PET的高预测价值，将对部分患者重新考虑肿瘤分期和治疗策略。
