Byrne A M, Hill A D K, Skehan S J, McDermott E W, O'Higgins N J
Surgical Professorial Unit, University College Dublin, Ireland.
Br J Surg. 2004 Nov;91(11):1398-409. doi: 10.1002/bjs.4791.
Breast cancer is the commonest cause of cancer death in women in the Western world, and imaging is essential in its diagnosis and staging. Metabolic imaging is a novel approach to improving the detection of cancers, as malignant transformation of cells is often associated with increased metabolic activity. This review assesses the possible role of positron emission tomography (PET) as a single non-invasive imaging modality to replace or complement current imaging and surgical practices in the diagnosis and staging of breast cancer.
A Medline search was performed and articles were cross-referenced with other relevant material. Evaluation of primary breast cancer with PET has shown a sensitivity of between 64 and 100 per cent and a specificity of 33-100 per cent; diagnostic accuracy appears to be related to tumour size. Difficulties arise in altered fluorodeoxyglucose uptake in lobular carcinoma, carcinoma in situ and benign inflammatory breast disease. In axillary staging, sensitivities of between 25 and 100 per cent have been reported, but with a false-negative of up to 20 per cent. In the assessment of distant metastasis and asymptomatic patients with raised levels of tumour markers, PET was superior to conventional imaging modalities.
PET is not a single diagnostic and staging tool that can replace current surgical, histological and radiological staging. Its main role in breast cancer lies in the investigation of metastatic disease and the evaluation of pathological response to various chemotherapeutic regimens.
在西方世界，乳腺癌是女性癌症死亡的最常见原因，影像学检查对其诊断和分期至关重要。代谢成像作为一种改善癌症检测的新方法，因为细胞的恶性转化通常与代谢活性增加有关。本综述评估正电子发射断层扫描（PET）作为一种单一的非侵入性成像方式，在乳腺癌诊断和分期中替代或补充当前成像及手术方法的潜在作用。
进行了医学文献数据库（Medline）检索，并将文章与其他相关资料相互参照。用PET评估原发性乳腺癌的敏感性为64%至100%，特异性为33%至100%；诊断准确性似乎与肿瘤大小有关。小叶癌、原位癌和良性炎性乳腺疾病中氟脱氧葡萄糖摄取改变会带来困难。在腋窝分期方面，报道的敏感性为25%至100%，但假阴性率高达20%。在评估远处转移以及肿瘤标志物水平升高的无症状患者时，PET优于传统成像方式。
PET并非一种能够替代当前手术、组织学和放射学分期的单一诊断及分期工具。其在乳腺癌中的主要作用在于对转移性疾病的研究以及对各种化疗方案病理反应的评估。
