Medical Faculty, Department of Diagnostic and Interventional Radiology, Univ Dusseldorf, 40225 Dusseldorf, Germany.
Eur J Nucl Med Mol Imaging. 2012 May;39(5):852-63. doi: 10.1007/s00259-012-2077-0. Epub 2012 Mar 6.
This retrospective study aimed (1) to compare the diagnostic accuracy of whole-body FDG PET/CT for initial breast cancer staging with the accuracy of a conventional, multimodal imaging algorithm, and (2) to assess potential alteration in patient management based on the FDG PET/CT findings.
Patients with primary breast cancer (106 women, mean age 57 ± 13 years) underwent whole-body FDG PET/CT and conventional imaging (X-ray mammography, MR mammography, chest plain radiography, bone scintigraphy and breast, axillary and liver ultrasonography). The diagnostic accuracies of FDG PET/CT and a conventional algorithm were compared. Diagnostic accuracy was assessed in terms of primary tumour detection rate, correct assessment of primary lesion focality, T stage and the detection rates for lymph node and distant metastases. Histopathology, imaging or clinical follow-up served as the standards of reference.
FDG PET/CT was significantly more accurate for detecting axillary lymph node and distant metastases (p = 0.0125 and p < 0.005, respectively). No significant differences were detected for other parameters. Synchronous tumours or locoregional extraaxillary lymph node or distant metastases were detected in 14 patients (13%) solely by FDG PET/CT. Management of 15 patients (14%) was altered based on the FDG PET/CT findings, including 3 patients with axillary lymph node metastases, 5 patients with extraaxillary lymph node metastases, 4 patients with distant metastases and 3 patients with synchronous malignancies.
Full-dose, intravenous contrast-enhanced FDG PET/CT was more accurate than conventional imaging for initial breast cancer staging due to the higher detection rate of metastases and synchronous tumours, although the study had several limitations including a retrospective design, a possible selection bias and a relevant false-positive rate for the detection of axillary lymph node metastases. FDG PET/CT resulted in a change of treatment in a substantial proportion of patients.
本回顾性研究旨在：（1）比较全身 FDG PET/CT 对初始乳腺癌分期的诊断准确性与传统多模态成像算法的准确性；（2）评估基于 FDG PET/CT 结果患者管理的潜在改变。
106 名原发性乳腺癌女性患者（平均年龄 57±13 岁）接受全身 FDG PET/CT 和常规影像学检查（X 射线乳房摄影术、MR 乳房摄影术、胸部平片、骨闪烁扫描和乳房、腋窝和肝脏超声检查）。比较 FDG PET/CT 和传统算法的诊断准确性。根据原发性肿瘤检出率、原发性病变局灶性的正确评估、T 分期以及淋巴结和远处转移的检出率评估诊断准确性。组织病理学、影像学或临床随访作为参考标准。
FDG PET/CT 对腋窝淋巴结和远处转移的检测明显更准确（p=0.0125 和 p<0.005）。其他参数未发现显著差异。14 名患者（13%）仅通过 FDG PET/CT 检测到同步肿瘤或局部区域外腋窝淋巴结或远处转移。15 名患者（14%）的管理因 FDG PET/CT 结果而改变，包括 3 名腋窝淋巴结转移患者、5 名额外腋窝淋巴结转移患者、4 名远处转移患者和 3 名同步恶性肿瘤患者。
由于转移和同步肿瘤的检出率更高，全剂量静脉内对比增强 FDG PET/CT 比传统成像更准确，尽管该研究存在一些局限性，包括回顾性设计、可能的选择偏倚以及腋窝淋巴结转移检测的相关假阳性率。FDG PET/CT 导致相当一部分患者的治疗发生改变。
