Chae Eun Young, Cha Joo Hee, Kim Hak Hee, Shin Hee Jung, Kim Hyun Ji, Oh Ha Yeun, Koh Young Hwan, Moon Dae Hyuk
Department of Radiology, Research Institute of Radiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
Acta Radiol. 2012 Jun 1;53(5):530-5. doi: 10.1258/ar.2012.120015. Epub 2012 May 16.
With the widespread use of PET/CT, incidental hypermetabolic foci unrelated to the known malignancy have been described with increasing frequency.
To determine the frequency and clinical significance of incidental focal hypermetabolic uptake in the breast as detected by 18F-FDG PET/CT, and to explore factors differentiating benign and malignant breast uptake.
From January 2005 to June 2010, a total of 51,971 whole-body FDG PET/CT examinations were performed in our clinic. After excluding 7254 sets of PET/CT data from patients known to have breast cancer, we retrospectively identified patients showing incidental focal hypermetabolic activity in the breast. Of 44,717 PET/CT examinations conducted on 32,988 patients, we identified 131 patients with no previous known or suspected benign and malignant breast disease. The etiology, mean SUV(max), and diameter of breast lesions were assessed. We also compared the presentation of the lesions on CT, mammography, and ultrasonography.
Of the 131 patients, 60 were histologically diagnosed with breast lesions, including 32 with malignant and 28 with benign lesions. An additional 11 patients were followed-up for more than 2 years and were clinically considered to have benign lesions. The remaining 60 patients who had neither histologic confirmation nor followed-up for more than 2 years were excluded. Therefore, 71 patients were finally included. The mean SUV(max) of 39 benign lesions and 32 malignant lesions were 2.02 ± 1.52 and 3.71 ± 3.83, respectively (P = 0.0001). At a cut-off value of 2.3, the rate of malignancy and specificity of the mean SUVmax for differentiating benign and malignant breast lesions were 61.3%, 76.3, respectively. The CT data from PET/CT revealed that the mean diameters of benign and malignant lesions were 1.19 ± 0.97 cm and 2.26 ± 1.96 cm, respectively (P = 0.0009).
Incidental focal 18F-FDG uptake in the breast as detected by PET/CT was indicative of malignancy in 45% of patients. Both mean SUV(max) and diameter were greater for malignant than benign lesions.
随着PET/CT的广泛应用，与已知恶性肿瘤无关的偶然发现的高代谢灶的报道日益增多。
确定18F-FDG PET/CT检测到的乳腺偶然局灶性高代谢摄取的频率及临床意义，并探讨区分乳腺良性和恶性摄取的因素。
2005年1月至2010年6月，我院共进行了51971例全身FDG PET/CT检查。在排除7254例已知患有乳腺癌患者的PET/CT数据后，我们回顾性地确定了乳腺出现偶然局灶性高代谢活性的患者。在对32988例患者进行的44717例PET/CT检查中，我们确定了131例既往无已知或疑似乳腺良恶性疾病的患者。评估了乳腺病变的病因、平均SUV（最大值）和直径。我们还比较了病变在CT、乳腺X线摄影和超声检查中的表现。
131例患者中，60例经组织学诊断为乳腺病变，其中32例为恶性，28例为良性。另外11例患者随访超过2年，临床认为患有良性病变。其余60例既无组织学证实也未随访超过2年的患者被排除。因此，最终纳入71例患者。39例良性病变和32例恶性病变的平均SUV（最大值）分别为2.02±1.52和3.71±3.83（P = 0.0001）。以2.3为临界值，区分乳腺良恶性病变的平均SUV最大值的恶性率和特异性分别为61.3%、76.3%。PET/CT的CT数据显示，良性和恶性病变的平均直径分别为1.19±0.97 cm和2.26±1.96 cm（P = 0.0009）。
PET/CT检测到的乳腺偶然局灶性18F-FDG摄取在45%的患者中提示恶性。恶性病变的平均SUV（最大值）和直径均大于良性病变。
