Ⅱ-Ⅲ 期乳腺癌新辅助化疗期间 ¹⁸F-FDG PET/CT 早期评估腋窝反应：对腋窝手术处理的影响。
Early assessment of axillary response with ¹⁸F-FDG PET/CT during neoadjuvant chemotherapy in stage II-III breast cancer: implications for surgical management of the axilla.
机构信息
Department of Nuclear Medicine, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
出版信息
Ann Surg Oncol. 2013 Jul;20(7):2227-35. doi: 10.1245/s10434-013-2902-0. Epub 2013 Mar 1.
BACKGROUND
If all initially node-positive patients undergo axillary lymph node dissection (ALND) after neoadjuvant chemotherapy (NAC), overtreatment may occur in patients with complete response. Positron emission tomography-computed tomography (PET/CT) during NAC may predict axillary response and select patients appropriate for less invasive treatment after NAC. We evaluated the value of sequential (18)F fluorodeoxyglucose (FDG) PET/CTs during NAC for axillary response monitoring in stage II-III breast cancer.
METHODS
A total of 219 PET/CTs were performed in 80 patients with cytology-proven, node-positive disease at baseline (PET/CT1, n = 80) and twice during NAC (PET/CT2 n = 62, PET/CT3, n = 77). The relative changes in maximum standardized uptake value (SUVmax) of axillary nodes were examined for their ability to assess pathological response. All patients underwent ALND after chemotherapy, and complete axillary response (pCR), defined as absence of isolated tumor cells and of micro- and macrometastases, served as the reference standard.
RESULTS
A total of 32 (40 %) patients experienced axillary pCR. The relative decrease in SUVmax was significantly higher in patients with pCR than in those without, both on PET/CT2 (p < 0.001) and PET/CT3 (p = 0.025). The area under the receiver operating characteristic curve values for PET/CT2 and PET/CT3 were 0.80 (95 % confidence interval 0.68-0.92) and 0.65 (95 % confidence interval 0.52-0.79), respectively. A relative decrease of ≥60 % on PET/CT2 had an excellent specificity (35 of 37, 95 %), a high positive predictive value (12 of 14, 86 %), and a sensitivity of 48 %-that is, it accurately identified histologic pCR in 12 of 25 patients with disease that responded to therapy.
CONCLUSIONS
(18)F-FDG PET/CT early during NAC is useful for axillary response monitoring in cytology-proven node-positive breast cancer because it identifies pathological response, thus permitting ALND to be spared.
背景
如果所有初始淋巴结阳性的患者在新辅助化疗（NAC）后均接受腋窝淋巴结清扫术（ALND），则完全缓解的患者可能会过度治疗。在 NAC 期间进行正电子发射断层扫描-计算机断层扫描（PET/CT）可以预测腋窝反应，并选择适合 NAC 后接受微创治疗的患者。我们评估了在 II 期至 III 期乳腺癌中，NAC 期间连续（18）F 氟脱氧葡萄糖（FDG）PET/CT 用于腋窝反应监测的价值。
方法
80 例细胞学证实的淋巴结阳性疾病患者共进行了 219 次 PET/CT（PET/CT1，n=80；PET/CT2，n=62；PET/CT3，n=77）。腋窝淋巴结最大标准化摄取值（SUVmax）的相对变化用于评估病理反应。所有患者在化疗后均接受 ALND，完全腋窝反应（pCR）定义为无孤立肿瘤细胞和微转移及宏转移，作为参考标准。
结果
共有 32 例（40%）患者发生腋窝 pCR。在 PET/CT2（p<0.001）和 PET/CT3（p=0.025）上，pCR 患者的 SUVmax 相对降低均显著高于无 pCR 患者。PET/CT2 和 PET/CT3 的受试者工作特征曲线下面积值分别为 0.80（95%置信区间 0.68-0.92）和 0.65（95%置信区间 0.52-0.79）。PET/CT2 上的相对降低≥60%具有优异的特异性（35/37，95%）、高阳性预测值（12/14，86%）和 48%的敏感性-也就是说，它在 25 例对治疗有反应的患者中准确识别了组织学 pCR。
结论
（18）F-FDG PET/CT 在 NAC 早期对细胞学证实的淋巴结阳性乳腺癌的腋窝反应监测很有用，因为它可以识别病理反应，从而避免 ALND。
Zotero 插件