Manohar Kuruva, Mittal Bhagwant Rai, Senthil Raja, Kashyap Raghava, Bhattacharya Anish, Singh Gurpreet
Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Nucl Med Commun. 2012 Jun;33(6):591-6. doi: 10.1097/MNM.0b013e3283516716.
Although initial studies have shown the utility of fluorine-18 fluorodeoxyglucose (F-18 FDG) PET in the detection and restaging of recurrent breast carcinoma, scarce literature exists on F-18 FDG PET/computed tomography (CT). This retrospective study was carried out to evaluate the role of F-18-FDG PET/CT in recurrent breast carcinoma and its impact on management.
Retrospective analysis of data of 111 patients who underwent F-18 FDG PET/CT and were suspected of having recurrent breast carcinoma was carried out. PET/CT imaging was carried out for distant metastases in histologically proven locoregional recurrence in 23 patients, clinically suspicious locoregional recurrence in nine patients, increasing tumour markers in two patients, suspicion of distant metastatic disease in 61 patients or as a part of surveillance in 16 patients. The final diagnosis of recurrence and stage of disease was made after histopathological analysis, correlative imaging and clinical or imaging follow-up of at least 6 months.
The final diagnosis of recurrent breast carcinoma was made in 76 patients and no evidence of recurrence was found in the remaining 35 patients. Locoregional disease requiring local radiotherapy or surgery was diagnosed in 14 patients and distant metastatic disease was diagnosed in 62 patients. FDG PET/CT was true positive in 75 patients, false positive in six patients, true negative in 35 patients and false negative in one patient, with a sensitivity, specificity, positive predictive value and a negative predictive value of 98.7, 85.3, 92.5 and 97.2%, respectively. FDG PET/CT also accurately restaged 22/23 patients with proven locoregional recurrence with an accuracy of 95.45%. Of 53 patients suspected of having distant metastatic disease on other imaging modalities, true distant metastatic disease was diagnosed in 36 patients and FDG PET/CT identified true metastatic disease in 35/36 patients, accurately ruling out metastases in the remaining 17 patients, and was false negative in one patient. In addition to confirming distant metastatic disease, it revealed more metastatic sites in 22 patients. Overall, F-18 FDG PET/CT had a major impact on management in 41% of the 103 patients being analysed for a major change in treatment.
F-18 FDG PET/CT is a very sensitive and specific imaging tool in detecting and restaging recurrent breast carcinoma. It can be a very useful imaging tool for restaging locoregional recurrences, and as a one-stop shop imaging technique to confirm suspicious metastatic disease on conventional imaging and to define the total burden of disease.
尽管初步研究已显示氟-18氟脱氧葡萄糖（F-18 FDG）PET在复发性乳腺癌的检测和再分期中具有实用价值，但关于F-18 FDG PET/计算机断层扫描（CT）的文献却很少。本回顾性研究旨在评估F-18-FDG PET/CT在复发性乳腺癌中的作用及其对治疗管理的影响。
对111例行F-18 FDG PET/CT检查且怀疑患有复发性乳腺癌的患者数据进行回顾性分析。对23例经组织学证实为局部区域复发、9例临床怀疑局部区域复发、2例肿瘤标志物升高、61例怀疑远处转移疾病或16例作为监测一部分的患者进行PET/CT成像以检测远处转移。在组织病理学分析、相关影像学检查以及至少6个月的临床或影像学随访后，做出复发和疾病分期的最终诊断。
76例患者最终诊断为复发性乳腺癌，其余35例患者未发现复发证据。14例患者被诊断为需要局部放疗或手术的局部区域疾病，62例患者被诊断为远处转移疾病。FDG PET/CT在75例患者中为真阳性，6例为假阳性，35例为真阴性，1例为假阴性，其敏感性、特异性、阳性预测值和阴性预测值分别为98.7%、85.3%、92.5%和97.2%。FDG PET/CT还准确地对23例经证实为局部区域复发的患者中的22例进行了再分期，准确率为95.45%。在53例其他影像学检查怀疑有远处转移疾病的患者中，36例被诊断为真正的远处转移疾病，FDG PET/CT在36例中的35例中识别出真正的转移疾病，准确排除了其余17例患者的转移，1例为假阴性。除了确认远处转移疾病外，它还在22例患者中发现了更多的转移部位。总体而言，在接受分析的103例患者中，41%的患者因治疗方案的重大改变，F-18 FDG PET/CT对治疗管理产生了重大影响。
F-18 FDG PET/CT是检测和再分期复发性乳腺癌的一种非常敏感和特异的成像工具。它对于局部区域复发的再分期可能是一种非常有用的成像工具，并且作为一种一站式成像技术，可用于确认传统影像学上可疑的转移疾病并确定疾病的总负担。
