Department of Nuclear Medicine and PET Center, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
Department of Breast and Endocrine Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
Jpn J Radiol. 2016 Mar;34(3):220-8. doi: 10.1007/s11604-015-0515-1. Epub 2015 Dec 29.
To investigate the diagnostic and prognostic value of (18)F-FDG-PET/CT for axillary lymph node (LN) staging in breast cancer patients, employing histologic evaluation as the reference.
Among 196 patients with biopsy-proven breast cancer who had undergone (18)F-FDG-PET/CT before mastectomy or breast-conserving surgery with sentinel LN biopsy and/or axillary LN dissection, 200 axillae were retrospectively analyzed by visual assessment and quantitatively using SUVmax. LN SUVmax as well as other clinicopathological features were assessed for their prognostic value using the log-rank test and Cox method.
Metastasis was diagnosed histopathologically in 56 (28 %) axillae. The sensitivity, specificity, and accuracy of visual PET/CT for diagnosing node metastasis were 55.4, 95.8, and 84.5 %, respectively. When the optimal discriminative SUVmax cutoff was 1.5, these figures were 51.8, 97.2, and 84.5 %, respectively. Fourteen of 55 patients (25.5 %) with LN metastases suffered a recurrence during follow-up (median 39 months). Patients with a high nodal SUVmax (≥1.7) had a significantly lower progression-free survival rate than those with a low SUVmax (p = 0.0499). Axillary nodal and primary tumor SUVmax as well as estrogen receptor status were significantly associated with recurrence.
Axillary nodal SUVmax may be a prognostic indicator of disease recurrence in patients with axillary LN metastases.
通过组织学评估作为参考，研究 (18)F-FDG-PET/CT 对乳腺癌患者腋窝淋巴结 (LN) 分期的诊断和预后价值。
在 196 例经活检证实的乳腺癌患者中，在乳房切除术或保乳手术前进行了 (18)F-FDG-PET/CT 检查，其中包括前哨淋巴结活检和/或腋窝淋巴结清扫术，回顾性分析了 200 个腋窝。采用视觉评估和 SUVmax 定量对 LN SUVmax 以及其他临床病理特征进行评估，采用对数秩检验和 Cox 方法评估其预后价值。
56 个（28%）腋窝组织学诊断为转移。视觉 PET/CT 诊断淋巴结转移的敏感性、特异性和准确性分别为 55.4%、95.8%和 84.5%。当最佳区分 SUVmax 截止值为 1.5 时，这些数字分别为 51.8%、97.2%和 84.5%。在 55 例（25.5%）有淋巴结转移的患者中，有 14 例在随访期间（中位时间 39 个月）复发。淋巴结 SUVmax 较高（≥1.7）的患者无进展生存率明显低于 SUVmax 较低的患者（p=0.0499）。腋窝淋巴结和原发肿瘤 SUVmax 以及雌激素受体状态与复发显著相关。
腋窝淋巴结 SUVmax 可能是腋窝淋巴结转移患者疾病复发的预后指标。
