Evangelista L, Baretta Z, Vinante L, Bezzon E, De Carolis V, Cervino A R, Gregianin M, Ghiotto C, Saladini G, Pomerri F, Muzzio P C
Radiotherapy and Nuclear Medicine Unit, Istituto Oncologico Veneto (IOV - IRCCS), Padua, Italy.
Q J Nucl Med Mol Imaging. 2012 Aug;56(4):375-84.
The purpose of the study was to assess the comparison of 18F-FDG PET/CT and CT in patients with breast cancer (BC) already treated with primary therapy, in evaluating the diagnostic and prognostic values.
We retrospectively studied 190 patients (187 women and 3 men, mean age 61±11 years) with previous BC (all stages) after surgery and other primary treatments. They underwent within three months CT and 18F-FDG PET/CT examinations for the evaluation of disease status. Disease relapse was confirmed by clinical evaluation and/or radiological findings. Survival curves of disease-free survival (DFS) and overall survival (OS) were computed using Kaplan-Meier method. Cox analysis regression was used to determine predictive factors of DFS and OS.
Of the overall 190 patients, 82 (43%) had evidence of clinical and/or imaging disease relapse, while 108 (57%) did not. Sensitivity, specificity, negative predictive and positive predictive values for disease relapse or progression were of 89% vs. 77%, 73% vs. 53%, 90% vs. 75% and 72% vs. 55%, respectively for PET/CT and CT. DFS curves were significantly different in patients with both negative and positive PET/CT and CT (log-rank test 33.6; P<0.0001 and 12.7; P=0.003, respectively). OS curves were similar in patients with positive/negative PET/CT and CT (P=NS). By both univariate and multivariate Cox regression analysis positive PET/CT was found to be related to the disease recurrence (HR 0.18 and 0.20, both P<0.0001, respectively).
PET/CT is more accurate than CT in identification of disease relapse in a large population of BC patients. In women at high-risk of recurrence, PET/CT imaging can provide the early detection of BC metastases, tailoring a proper treatment.
本研究旨在评估已接受初始治疗的乳腺癌（BC）患者中，18F-FDG PET/CT与CT在评估诊断和预后价值方面的比较。
我们回顾性研究了190例（187例女性和3例男性，平均年龄61±11岁）既往患有BC（各期）且已接受手术及其他初始治疗的患者。他们在三个月内接受了CT和18F-FDG PET/CT检查以评估疾病状态。疾病复发通过临床评估和/或影像学检查结果得以证实。采用Kaplan-Meier法计算无病生存期（DFS）和总生存期（OS）的生存曲线。使用Cox分析回归来确定DFS和OS的预测因素。
在总共190例患者中，82例（43%）有临床和/或影像学疾病复发的证据，而108例（57%）没有。PET/CT和CT对于疾病复发或进展的敏感性、特异性、阴性预测值和阳性预测值分别为89%对77%、73%对53%、90%对75%以及72%对55%。PET/CT和CT结果为阴性及阳性的患者，其DFS曲线存在显著差异（对数秩检验分别为33.6；P<0.0（此处原文有误，推测应为P<0.0001）和12.7；P=0.003）。PET/CT和CT结果为阳性/阴性的患者，其OS曲线相似（P=无显著差异）。通过单因素和多因素Cox回归分析发现，PET/CT阳性与疾病复发相关（风险比分别为0.18和0.20，均P<0.0001）。
在大量BC患者中，PET/CT在识别疾病复发方面比CT更准确。对于复发高危女性，PET/CT成像可实现BC转移灶的早期检测，从而制定合适的治疗方案。
