Trehan Romeeta, Seam Rajeev K, Gupta Manoj K, Sood Ashwani, Dimri Kislay, Mahajan Rohit
Department of Radiotherapy, Government Medical College and Hospital, Chandigarh, India.
Department of Radiotherapy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
World J Nucl Med. 2014 Sep;13(3):163-9. doi: 10.4103/1450-1147.144816.
Locally advanced breast cancer (LABC) is a common cancer in the developing countries. Neoadjuvant chemotherapy (NACT) is a very important step in the treatment of such tumors and hence that the disease can be down staged and made amenable for surgery. All the tumors do not respond to the therapy equally. Hence, it becomes very important to predict the response of chemotherapy in such cases. This study evaluated the role of scintimammography in assessing the response to NACT in 23 patients with LABC. Histologically proven 23 patients of LABC were recruited in this study. Prechemotherapy tumor size was measured clinically in all patients and technitium (Tc)-99m sestamibi test was performed before NACT for each patient. Early (10 min) and delayed (2 h) image of the breast were acquired in anterior and lateral views after Tc-99m sestamibi intravenous injections and wash out rate (WOR) was computed. After 3-4 cycles of chemotherapy, surgery in the form of modified radical mastectomy was performed in 20 out of 23 patients (3 patients lost to follow-up) with pathologic evaluation of the residual tumor size. The pretherapy Tc-99m sestamibi WOR ranged from 8.3% to 68% with mean ± SD of 34.5% ±16.5%. The prechemotherapy Tc-99m sestamibi study predicted chemoresistance (WOR >45%) in 6 out of 20 patients and no chemoresistance (WOR <45%) in 14 out of 20 patients. When the WOR cut-off was set at >45%, the predictivity of the test was indicated by sensitivity of 91.7%, specificity of 62.5%, positive predictive value of 78.6%, and negative predictive value of 82.3% with a likelihood ratio of 0.1. Tc-99m sestamibi WOR is a reliable test for predicting tumor response to NACT. WOR >45% is highly predictive of chemoresistance with likelihood ratio of 0.1 than WOR <45% being predictive of chemoresponsiveness.
局部晚期乳腺癌（LABC）在发展中国家是一种常见癌症。新辅助化疗（NACT）是此类肿瘤治疗中非常重要的一步，通过它可以使疾病降期并适合手术。并非所有肿瘤对该疗法的反应都相同。因此，预测此类病例中化疗的反应变得非常重要。本研究评估了乳腺闪烁显像在评估23例LABC患者对NACT反应中的作用。本研究招募了23例经组织学证实的LABC患者。所有患者均在临床测量化疗前肿瘤大小，并且在每位患者进行NACT之前进行锝（Tc）-99m 甲氧基异丁基异腈检查。在静脉注射Tc-99m甲氧基异丁基异腈后，从前位和侧位获取乳房的早期（10分钟）和延迟（2小时）图像，并计算洗脱率（WOR）。在进行3 - 4个周期的化疗后，23例患者中有20例（3例失访）接受了改良根治性乳房切除术形式的手术，并对残余肿瘤大小进行了病理评估。治疗前Tc-99m甲氧基异丁基异腈WOR范围为8.3%至68%，平均±标准差为34.5%±16.5%。化疗前Tc-99m甲氧基异丁基异腈研究预测20例患者中有6例化疗耐药（WOR>45%），20例患者中有14例无化疗耐药（WOR<45%）。当WOR临界值设定为>45%时，该检测的预测性表现为灵敏度91.7%、特异性62.5%、阳性预测值78.6%、阴性预测值82.3%，似然比为0.1。Tc-99m甲氧基异丁基异腈WOR是预测肿瘤对NACT反应的可靠检测方法。WOR>45%高度预测化疗耐药，似然比为0.1，而WOR<45%预测化疗反应性。
