Service de Médecine nucléaire, Saint-Cloud, France.
Eur J Nucl Med Mol Imaging. 2013 Aug;40(8):1206-13. doi: 10.1007/s00259-013-2405-z. Epub 2013 May 3.
Inflammatory breast cancer (IBC) is the most aggressive type of breast cancer with a poor prognosis. Locoregional staging is based on dynamic contrast-enhanced (DCE) CT or MRI. The aim of this study was to compare the performances of FDG PET/CT and DCE CT in locoregional staging of IBC and to assess their respective prognostic values.
The study group comprised 50 women (median age: 51 ± 11 years) followed in our institution for IBC who underwent FDG PET/CT and DCE CT scans (median interval 5 ± 9 days). CT enhancement parameters were net maximal enhancement, net early enhancement and perfusion.
The PET/CT scans showed intense FDG uptake in all primary tumours. Concordance rate between PET/CT and DCE CT for breast tumour localization was 92%. No significant correlation was found between SUVmax and CT enhancement parameters in primary tumours (p > 0.6). PET/CT and DCE CT results were poorly correlated for skin infiltration (kappa = 0.19). Ipsilateral foci of increased axillary FDG uptake were found in 47 patients (median SUV: 7.9 ± 5.4), whereas enlarged axillary lymph nodes were observed on DCE CT in 43 patients. Results for axillary node involvement were fairly well correlated (kappa = 0.55). Nineteen patients (38%) were found to be metastatic on PET/CT scan with a significant shorter progression-free survival than patients without distant lesions (p = 0.01). In the primary tumour, no statistically significant difference was observed between high and moderate tumour FDG uptake on survival, using an SUVmax cut-off of 5 (p = 0.7 and 0.9), or between high and low tumour enhancement on DCE CT (p > 0.8).
FDG PET/CT imaging provided additional information concerning locoregional involvement to that provided by DCE CT on and allowed detection of distant metastases in the same whole-body procedure. Tumour FDG uptake or CT enhancement parameters were not correlated and were not found to have any prognostic value.
炎性乳腺癌（IBC）是最具侵袭性的乳腺癌类型，预后较差。局部区域分期基于动态对比增强（DCE）CT 或 MRI。本研究旨在比较 FDG PET/CT 和 DCE CT 在 IBC 局部区域分期中的性能，并评估它们各自的预后价值。
本研究组纳入了在我院接受 IBC 治疗的 50 名女性患者（中位年龄：51±11 岁），她们均接受了 FDG PET/CT 和 DCE CT 扫描（中位间隔 5±9 天）。CT 增强参数包括净最大增强、净早期增强和灌注。
所有原发性肿瘤在 PET/CT 扫描中均显示出强烈的 FDG 摄取。PET/CT 和 DCE CT 对乳房肿瘤定位的一致性率为 92%。SUVmax 与原发性肿瘤 CT 增强参数之间无显著相关性（p>0.6）。PET/CT 和 DCE CT 结果对皮肤浸润的相关性较差（kappa=0.19）。47 例患者同侧腋窝 FDG 摄取增加（中位 SUV：7.9±5.4），而 43 例患者在 DCE CT 上观察到腋窝淋巴结肿大。腋窝淋巴结受累的结果相关性较好（kappa=0.55）。19 例（38%）患者在 PET/CT 扫描中发现转移灶，其无进展生存期明显短于无远处病变的患者（p=0.01）。在原发性肿瘤中，使用 SUVmax 截断值 5 时，高和中肿瘤 FDG 摄取之间的生存差异无统计学意义（p=0.7 和 0.9），或在 DCE CT 上高和低肿瘤增强之间的差异无统计学意义（p>0.8）。
FDG PET/CT 成像提供了 DCE CT 提供的局部区域受累的额外信息，并在同一全身程序中检测到远处转移。肿瘤 FDG 摄取或 CT 增强参数之间无相关性，且无预后价值。
