Buchbender Christian, Kuemmel Sherko, Hoffmann Oliver, Stahl Alexander R, Kimmig Rainer, Otterbach Friedrich, Ladd Susanne, Koeninger Angela, Forsting Michael, Bockisch Andreas, Antoch Gerald, Heusner Till A
Univ Dusseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Dusseldorf, Germany.
Acta Radiol. 2012 Jul;53(6):628-36. doi: 10.1258/ar.2012.110699. Epub 2012 Jul 3.
Up to about one-quarter of patients treated with neoadjuvant chemotherapy do not adequately respond to the given treatment. By a differentiation between responders and non-responders ineffective toxic therapies can be prevented.
To retrospectively test if FDG-PET/CT is able to early differentiate between breast cancer lesions with pathological complete response (pCR) and lesions without pathological complete response (npCR) after two cycles of neoadjuvant chemotherapy (NACT).
In this retrospective study 26 breast cancer patients (mean age, 46.9 years ± 9.9 years) underwent a pre-therapeutic FDG-PET/CT scan and a subsequent FDG-PET/CT after the second cycle of NACT. Histopathology of resected specimen served as the reference standard. Maximum standardized uptake values (SUVmax) of cancer lesions before and after the second cycle of NACT were measured. Two evaluation algorithms were used: (a) pCR: Sinn Score 3 and 4, npCR: Sinn Score 0-2; (b) pCR: Sinn Score 4, npCR: Sinn Score 0-3. The absolute and relative decline of the SUVmax (ΔSUVmax, ΔSUVmax(%))was calculated. Differences of the SUVmax as well as of the SUVmax decline between pCR lesions and npCR lesions were tested for statistical significance P < 0.05. To identify the optimal cut-off value of ΔSUVmax(%) to differentiate between pCR lesions and npCR lesions a receiver-operating curve (ROC) analysis was performed.
Using evaluation algorithm A the ΔSUVmax was 13.5 (pCR group) and 3.9 (npCR group) (P = 0.006); the ΔSUVmax(%) was 79% and 47%, respectively (P = 0.001). On ROC analysis an optimal cut-off ΔSUVmax(%) of 66% was found. Using evaluation algorithm B the ΔSUVmax was 17.5 (pCR group) and 4.9 (npCR group) (P = 0.013); the ΔSUVmax(%) was 89% and 51%, respectively (P = 0.003). On ROC analysis an optimal cut-off ΔSUVmax(%) of 88% was found.
FDG-PET/CT may be able to early differentiate between pCR and npCR of primary breast cancer lesions after two cycles of NACT.
接受新辅助化疗的患者中，高达约四分之一对给定治疗反应不佳。通过区分反应者和无反应者，可以避免无效的毒性治疗。
回顾性检验氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）能否在新辅助化疗（NACT）两个周期后早期区分病理完全缓解（pCR）的乳腺癌病灶和未达到病理完全缓解（npCR）的病灶。
在这项回顾性研究中，26例乳腺癌患者（平均年龄46.9岁±9.9岁）在治疗前接受了FDG-PET/CT扫描，并在NACT第二个周期后接受了后续的FDG-PET/CT检查。切除标本的组织病理学作为参考标准。测量NACT第二个周期前后癌病灶的最大标准化摄取值（SUVmax）。使用了两种评估算法：（a）pCR：辛恩评分3和4，npCR：辛恩评分0 - 2；（b）pCR：辛恩评分4，npCR：辛恩评分0 - 3。计算SUVmax的绝对和相对下降值（ΔSUVmax，ΔSUVmax(%)）。检验pCR病灶和npCR病灶之间SUVmax以及SUVmax下降的差异是否具有统计学意义（P < 0.05）。为了确定区分pCR病灶和npCR病灶的ΔSUVmax(%)的最佳临界值，进行了受试者操作特征曲线（ROC）分析。
使用评估算法A时，ΔSUVmax在pCR组为13.5，在npCR组为3.9（P = 0.006）；ΔSUVmax(%)分别为79%和47%（P = 0.001）。在ROC分析中，发现最佳临界ΔSUVmax(%)为66%。使用评估算法B时，ΔSUVmax在pCR组为17.5，在npCR组为4.9（P = 0.013）；ΔSUVmax(%)分别为89%和51%（P = 0.003）。在ROC分析中，发现最佳临界ΔSUVmax(%)为88%。
FDG-PET/CT可能能够在NACT两个周期后早期区分原发性乳腺癌病灶的pCR和npCR。
