Ergul Nurhan, Kadioglu Huseyin, Yildiz Seyma, Yucel Serap Baskaya, Gucin Zuhal, Erdogan Ezgi Basak, Aydin Mehmet, Muslumanoglu Mahmut
Department of Nuclear Medicine, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
Department of Surgery, Bezmialem Vakif University School of Medicine, Istanbul, Turkey.
Acta Radiol. 2015 Aug;56(8):917-23. doi: 10.1177/0284185114539786. Epub 2014 Jul 10.
Non-invasive evaluation of the extent of axillary nodal involvement in early-stage breast cancer (ESBC) patients and accurate assessment of multifocality are both challenging. Few reports have explored whether 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) might be more useful than other diagnostic methods in these contexts.
To prospectively evaluate the diagnostic utility of FDG PET/CT, contrast-enhanced, and diffusion-weighted magnetic resonance imaging (DCE-MRI and DWI), and sentinel lymph node biopsy (SNB), in detection of axillary metastatic lymph nodes in ESBC patients; and to explore the utilities of FDG PET/CT and DCE-MRI for identification of multifocality.
Twenty-four female patients (mean age, 47 ± 9.9 years; range, 24-68 years) with ESBC underwent whole-body FDG PET/CT and breast MRI prior to operation. SNB and axillary lymph node dissection (ALND) were performed on all patients, as was mastectomy or wide local tumor excision. Histopathological findings served as the gold standard when evaluating either multifocality or axillary nodal involvement.
The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, of PET/CT and DCE-MRI, used to detect multifocality, were as follows: 67% versus 78%, 100% versus 53%, 100% versus 50%, 83% versus 80%, and 88% versus 63%. SNB afforded the highest sensitivity (93%) in terms of detection of axillary metastasis. The sensitivity, NPV, and accuracy of PET/CT were 67%, 62%, and 75% respectively, thus higher than the equivalent values of either DCE-MRI or DWI.
For assessment of multifocality in ESBC patients, highly specific results of PET/CT should be taken into account along with DCE-MRI findings. For evaluation of axillary nodal involvement, PET/CT has higher sensitivity, NPV, and accuracy values than DCE-MRI and DWI and may guide a surgical decision to proceed or not to SNB or ALND.
对早期乳腺癌（ESBC）患者腋窝淋巴结受累范围进行无创评估以及准确评估多灶性均具有挑战性。很少有报告探讨在这些情况下，18F-氟脱氧葡萄糖（FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）是否比其他诊断方法更有用。
前瞻性评估FDG PET/CT、对比增强磁共振成像（DCE-MRI）、扩散加权磁共振成像（DWI）以及前哨淋巴结活检（SNB）在检测ESBC患者腋窝转移性淋巴结中的诊断效用；并探讨FDG PET/CT和DCE-MRI在识别多灶性方面的效用。
24例ESBC女性患者（平均年龄47±9.9岁；范围24 - 68岁）在手术前行全身FDG PET/CT及乳腺MRI检查。所有患者均接受了SNB和腋窝淋巴结清扫（ALND），以及乳房切除术或局部广泛肿瘤切除术。在评估多灶性或腋窝淋巴结受累情况时，组织病理学结果作为金标准。
用于检测多灶性时，PET/CT和DCE-MRI的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）及准确性如下：分别为67%对78%、100%对53%、100%对50%、83%对80%、88%对63%。就检测腋窝转移而言，SNB的敏感性最高（93%）。PET/CT的敏感性、NPV及准确性分别为67%、62%和75%，高于DCE-MRI或DWI的相应值。
对于评估ESBC患者的多灶性，应将PET/CT的高特异性结果与DCE-MRI结果一并考虑。对于评估腋窝淋巴结受累情况，PET/CT比DCE-MRI和DWI具有更高的敏感性、NPV及准确性值，可能有助于指导是否进行SNB或ALND的手术决策。
