Radan Lea, Ben-Haim Simona, Bar-Shalom Rachel, Guralnik Luda, Israel Ora
Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel.
Cancer. 2006 Dec 1;107(11):2545-51. doi: 10.1002/cncr.22292.
Early diagnosis of recurrent breast cancer is crucial to selection of the most appropriate therapy. The current study evaluated the role of FDG-PET/CT in the assessment of suspected recurrent breast cancer in patients who presented with elevated serum tumor markers.
Forty-seven consecutive FDG-PET/CT studies of 46 women (aged 32-79 years; mean, 59.9 years) with a history of breast cancer presented with elevated serum tumor markers 1-21 years (mean = 6.2 years) after their initial diagnosis and were retrospectively evaluated. PET/CT results were confirmed by pathology (n = 11), further imaging, and follow-up (mean = 17.2 months; n = 36). Changes in further management based on PET/CT were recorded.
Thirty (65%) patients had tumor recurrence, and 16 (35%) patients showed no further evidence of disease. Thirty-one patients had 32 abnormal PET/CT studies, and 15 patients had normal studies with an overall sensitivity, specificity, and accuracy of 90%, 71%, and 83%, respectively. In 37 patients, PET/CT was compared with contrast-enhanced CT and had a higher sensitivity (85% vs 70%), specificity (76% vs 47%), and accuracy (81% vs 59%). PET/CT had an impact on the management of 24 (5l%) patients. Of these, chemotherapy or radiotherapy was started in 16 patients, treatment was modified in 2 patients, and 6 patients were referred to biopsy, followed by referral to surgery for 2 patients.
In patients with breast cancer and rising tumor markers, FDG-PET/CT had high performance indices and was superior to CT for diagnosis of tumor recurrence, which led to changes in the subsequent clinical management of 51% of these patients.
复发性乳腺癌的早期诊断对于选择最合适的治疗方法至关重要。本研究评估了氟代脱氧葡萄糖正电子发射断层显像暨计算机断层扫描（FDG-PET/CT）在血清肿瘤标志物升高的疑似复发性乳腺癌患者评估中的作用。
对46名患乳腺癌史的女性（年龄32 - 79岁；平均59.9岁）进行了连续47次FDG-PET/CT检查，这些患者在首次诊断后1 - 21年（平均 = 6.2年）出现血清肿瘤标志物升高，并进行回顾性评估。PET/CT结果由病理（n = 11）、进一步影像学及随访（平均 = 17.2个月；n = 36）证实。记录基于PET/CT的进一步治疗管理变化。
30名（65%）患者出现肿瘤复发，16名（35%）患者未发现疾病进一步证据。31名患者的PET/CT检查结果异常，15名患者检查结果正常，总体敏感性、特异性和准确性分别为90%、71%和83%。37名患者中，PET/CT与增强CT对比，前者具有更高的敏感性（85%对70%）、特异性（76%对47%）及准确性（81%对59%）。PET/CT对24名（51%）患者的治疗管理产生了影响。其中，16名患者开始化疗或放疗，2名患者治疗方案修改，6名患者接受活检，随后2名患者转诊手术。
对于乳腺癌且肿瘤标志物升高的患者，FDG-PET/CT具有较高的性能指标，在诊断肿瘤复发方面优于CT，导致51%的患者后续临床管理发生改变。
