From the Departments of *Radiology; †Surgery; ‡Breast Clinic, Department of Internal Medicine, Mayo Clinic, Rochester, MN; and §EPIC Imaging Center, Portland, OR.
Clin Nucl Med. 2013 Dec;38(12):949-56. doi: 10.1097/RLU.0000000000000248.
The objective of this study was to determine the ability of breast imaging with 99mTc-sestamibi and a direct conversion-molecular breast imaging (MBI) system to predict early response to neoadjuvant chemotherapy (NAC).
Patients undergoing NAC for breast cancer were imaged with a direct conversion-MBI system before (baseline), at 3 to 5 weeks after onset, and after completion of NAC. Tumor size and tumor-to-background (T/B) uptake ratio measured from MBI images were compared with extent of residual disease at surgery using the residual cancer burden.
Nineteen patients completed imaging and proceeded to surgical resection after NAC. Mean reduction in T/B ratio from baseline to 3 to 5 weeks for patients classified as RCB-0 (no residual disease), RCB-1 and RCB-2 combined, and RCB-3 (extensive residual disease) was 56% (SD, 0.20), 28% (SD, 0.20), and 4% (SD, 0.15), respectively. The reduction in the RCB-0 group was significantly greater than in RCB-1/2 (P = 0.036) and RCB-3 (P = 0.001) groups. The area under the receiver operator characteristic curve for determining the presence or absence of residual disease was 0.88. Using a threshold of 50% reduction in T/B ratio at 3 to 5 weeks, MBI predicted presence of residual disease at surgery with a diagnostic accuracy of 89.5% (95% confidence interval [CI], 0.64%-0.99%), sensitivity of 92.3% (95% CI, 0.74%-0.99%), and specificity of 83.3% (95% CI, 0.44%-0.99%). The reduction in tumor size at 3 to 5 weeks was not statistically different between RCB groups.
Changes in T/B ratio on MBI images performed at 3 to 5 weeks following initiation of NAC were accurate at predicting the presence or absence of residual disease at NAC completion.
本研究旨在确定 99mTc- sestamibi 乳腺成像和直接转换分子乳腺成像（MBI）系统预测新辅助化疗（NAC）早期反应的能力。
接受乳腺癌 NAC 的患者在 NAC 前（基线）、起始后 3 至 5 周以及 NAC 完成后使用直接转换-MBI 系统进行成像。使用残留癌负荷比较 MBI 图像上测量的肿瘤大小和肿瘤与背景（T/B）摄取比与手术时的残留疾病程度。
19 名患者完成成像并在 NAC 后进行手术切除。RCB-0（无残留疾病）、RCB-1 和 RCB-2 联合和 RCB-3（广泛残留疾病）患者从基线到 3 至 5 周 T/B 比值的平均降低分别为 56%（SD，0.20）、28%（SD，0.20）和 4%（SD，0.15）。RCB-0 组的降低明显大于 RCB-1/2 组（P=0.036）和 RCB-3 组（P=0.001）。确定是否存在残留疾病的接收器操作特征曲线下面积为 0.88。使用 3 至 5 周时 T/B 比值降低 50%的阈值，MBI 预测手术时存在残留疾病的诊断准确性为 89.5%（95%CI，0.64%-0.99%），灵敏度为 92.3%（95%CI，0.74%-0.99%），特异性为 83.3%（95%CI，0.44%-0.99%）。RCB 组之间 3 至 5 周时肿瘤大小的降低无统计学差异。
NAC 开始后 3 至 5 周进行的 MBI 图像上 T/B 比值的变化可准确预测 NAC 完成时残留疾病的存在或不存在。
