Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
Eur J Nucl Med Mol Imaging. 2010 Jun;37(6):1069-76. doi: 10.1007/s00259-009-1343-2. Epub 2010 Feb 4.
The aim of this study was to assess the accuracy of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT to visualize lymph node metastases before the start of neoadjuvant chemotherapy and to determine how often the visualization is sufficiently prominent to allow monitoring of the axillary response.
Thirty-eight patients with invasive breast cancer of >3 cm and/or lymph node metastasis underwent FDG PET/CT before neoadjuvant chemotherapy. The results of the FDG PET/CT were compared with those from ultrasonography with fine-needle aspiration (FNA) cytology or sentinel node biopsy. Patients suitable for response monitoring of the axilla were defined as having either a maximum standardized uptake value (SUV(max)) >or= 2.5 or a tumour to background ratio >or=5 in the most intense lymph node.
The sensitivity and specificity of FDG PET/CT in detecting axillary involvement were 97 and 100%, respectively. No difference existed between the SUV(max) of the primary tumour and that from the related most intense lymph node metastasis. Moreover, the mean tumour to background ratio was 90% higher in the lymph nodes compared to the primary tumour (p = 0.006). Ninety-three per cent of the patients had sufficient uptake in the lymph nodes to qualify for subsequent response monitoring of the axilla. A considerable distinction in metabolic activity was observed between the different subtypes of breast cancer. The mean SUV(max) in lymph node metastases of oestrogen receptor (ER)-positive, triple-negative and human epidermal growth factor receptor 2 (HER2)-positive tumours was 6.6, 11.6 and 6.6, respectively.
The high accuracy in visualizing lymph node metastases and the sufficiently high SUV(max) and tumour to background ratio at baseline suggest that it is feasible to monitor the axillary response with FDG PET/CT, especially in triple-negative tumours.
本研究旨在评估氟代脱氧葡萄糖(FDG)正电子发射断层扫描(PET)/CT 在新辅助化疗前可视化淋巴结转移的准确性,并确定其可视化的频率,以便监测腋窝的反应。
38 例浸润性乳腺癌>3cm 和/或淋巴结转移的患者在新辅助化疗前接受 FDG PET/CT 检查。FDG PET/CT 结果与超声引导下细针抽吸(FNA)细胞学或前哨淋巴结活检结果进行比较。适合腋窝反应监测的患者定义为最大标准化摄取值(SUV(max))>或=2.5 或最强烈的淋巴结中肿瘤与背景的比值>或=5。
FDG PET/CT 检测腋窝受累的灵敏度和特异性分别为 97%和 100%。原发肿瘤的 SUV(max)与相关最强烈的淋巴结转移灶的 SUV(max)无差异。此外,淋巴结的平均肿瘤与背景比值比原发肿瘤高 90%(p = 0.006)。93%的患者淋巴结摄取足够,有资格进行后续的腋窝反应监测。不同乳腺癌亚型之间观察到代谢活性的显著差异。ER 阳性、三阴性和人表皮生长因子受体 2(HER2)阳性肿瘤淋巴结转移的平均 SUV(max)分别为 6.6、11.6 和 6.6。
在可视化淋巴结转移方面具有较高的准确性,以及在基线时足够高的 SUV(max)和肿瘤与背景的比值表明,FDG PET/CT 监测腋窝反应是可行的,特别是在三阴性肿瘤中。