Chang Hong-Tai, Hu Chin, Chiu Yu-Li, Peng Nan-Jing, Liu Ren-Shyan
Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
Department of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
PLoS One. 2014 Dec 17;9(12):e115127. doi: 10.1371/journal.pone.0115127. eCollection 2014.
To evaluate the usefulness of 2-[18F] fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) in the early detection of breast cancer tumor recurrences and its role in post-therapy surveillance.
FDG-PET/CT was performed on patients with increased serum CA 15-3 levels and/or clinical/radiologic suspicion of recurrence. A group of asymptomatic patients who underwent FDG-PET/CT in the post-therapy surveillance of breast cancer served as the controls. The results were analyzed based on the patients' histological data, other imaging modalities and/or clinical follow-up. Recurrence was defined as evidence of recurrent lesions within 12 months of the FDG-PET/CT scan.
Based on elevated serum CA15-3 levels (n = 31) and clinical/radiologic suspicion (n = 40), 71 scans were performed due to suspected recurrence, whereas 69 scans were performed for asymptomatic follow-up. The sensitivity and specificity of FDG-PET/CT were 87.5% and 87.1% in the patients with suspected recurrence and 77.8% and 91.7% in the asymptomatic patients. The positive predictive value in the patients with suspected recurrence (mainly due to elevated serum CA 15-3 levels) was higher than that in asymptomatic patients (P = 0.013). Recurrences were proven in 56.3% (40/71) of the patients with suspected recurrence and in 13% (9/69) of the asymptomatic patients (P < 0.001). FDG-PET/CT resulted in changes in the planned management in 49.3% (35/71) of the patients with suspected recurrence and 10.1% (7/69) of the asymptomatic patients (P < 0.001). After follow-up, 77.5% (55/71) of the patients with suspicious recurrences and 97.1% (67/69) of the asymptomatic patients were surviving at the end of the study (P < 0.001).
FDG-PET/CT was able to detect recurrence, and the results altered the intended patient management in the post-therapy surveillance of breast cancer. FDG-PET/CT should be used as a priority in patients with increased serum CA 15-3 levels, or with clinical/radiologic suspicion of recurrence, and might be useful for asymptomatic patients.
评估2-[18F]氟-2-脱氧-D-葡萄糖正电子发射断层扫描/计算机断层扫描（FDG-PET/CT）在早期检测乳腺癌肿瘤复发中的作用及其在治疗后监测中的作用。
对血清CA 15-3水平升高和/或临床/影像学怀疑复发的患者进行FDG-PET/CT检查。一组在乳腺癌治疗后监测中接受FDG-PET/CT检查的无症状患者作为对照。根据患者的组织学数据、其他影像学检查和/或临床随访分析结果。复发定义为在FDG-PET/CT扫描后12个月内出现复发病变的证据。
基于血清CA15-3水平升高（n = 31）和临床/影像学怀疑（n = 40），因怀疑复发进行了71次扫描，而因无症状随访进行了69次扫描。在疑似复发的患者中，FDG-PET/CT的敏感性和特异性分别为87.5%和87.1%，在无症状患者中分别为77.8%和91.7%。疑似复发患者（主要由于血清CA 15-3水平升高）的阳性预测值高于无症状患者（P = 0.013）。在疑似复发的患者中，56.3%（40/71）被证实复发，在无症状患者中为13%（9/69）（P < 0.001）。FDG-PET/CT导致49.3%（35/71）的疑似复发患者和10.1%（7/69）的无症状患者的计划管理发生改变（P < 0.001）。随访后，在研究结束时，77.5%（55/71）的疑似复发患者和97.1%（67/69）的无症状患者存活（P < 0.001）。
FDG-PET/CT能够检测复发，其结果改变了乳腺癌治疗后监测中患者的预期管理。对于血清CA 15-3水平升高或临床/影像学怀疑复发的患者，应优先使用FDG-PET/CT，对无症状患者可能也有用。
