Hulikal Narendra, Gajjala Sivanath Reddy, Kalawat Teck Chand, Kottu Radhika, Amancharla Yadagiri Lakshmi
Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupathi, 517501 India.
Department of Nuclear Medicine, Sri Venkateswara Institute of Medical Sciences, Tirupathi, 517501 India.
Indian J Surg Oncol. 2015 Dec;6(4):330-6. doi: 10.1007/s13193-015-0421-0. Epub 2015 Jul 22.
In India up to 50 % of breast cancer patients still present as locally advanced breast cancer (LABC). The conventional methods of metastatic work up include physical examination, bone scan, chest & abdominal imaging, and biochemical tests. It is likely that the conventional staging underestimates the extent of initial spread and there is a need for more sophisticated staging procedure. The PET/CT can detect extra-axillary and occult distant metastases and also aid in predicting response to chemotherapy at an early point in time. To evaluate the utility of FDG PET/CT in initial staging and response assessment of patients with LABC receiving NACT. A prospective study of all biopsy confirmed female patients diagnosed with LABC receiving NACT from April 2013 to May 2014. The conventional work up included serum chemistry, CECT chest and abdomen and bone scan. A baseline whole body PET/CT was done in all patients. A repeat staging evaluation and a whole body PET/CT was done after 2/3rd cycle of NACT in non-responders and after 3/4 cycles in clinical responders. The histopathology report of the operative specimen was used to document the pathological response. The FDG PET/CT reported distant metastases in 11 of 38 patients, where as conventional imaging revealed metastases in only 6. Almost all the distant lesions detected by conventional imaging were detected with PET/CT, which showed additional sites of metastasis in 3 patients. In 2 patients, PET/CT detected osteolytic bone metastasis which were not detected by bone scan. In 5 patients PET CT detected N3 disease which were missed on conventional imaging. A total of 14 patients had second PET/CT done to assess the response to NACT and 11 patients underwent surgery. Two patients had complete pathological response. Of these 1 patient had complete metabolic and morphologic response and other had complete metabolic and partial morphologic response on second PET/CT scan. The 18 FDG PET/CT can detect more number of metastasis as well as additional sites of metastasis compared to conventional methods. The response assessment resulted in change of treatment regimen in 14 % of patients.
在印度，高达50%的乳腺癌患者就诊时仍为局部晚期乳腺癌（LABC）。传统的转移灶检查方法包括体格检查、骨扫描、胸部及腹部影像学检查以及生化检测。传统分期很可能低估了初始转移的范围，因此需要更精确的分期程序。PET/CT能够检测腋窝外及隐匿性远处转移灶，还有助于在早期预测化疗反应。为评估FDG PET/CT在接受新辅助化疗（NACT）的LABC患者初始分期及反应评估中的作用。对2013年4月至2014年5月间所有经活检确诊为LABC并接受NACT的女性患者进行了一项前瞻性研究。传统检查包括血清生化、胸部及腹部增强CT（CECT）以及骨扫描。所有患者均进行了基线全身PET/CT检查。对无反应者在NACT的2/3周期后、临床反应者在3/4周期后进行重复分期评估及全身PET/CT检查。手术标本的组织病理学报告用于记录病理反应。FDG PET/CT报告38例患者中有11例存在远处转移，而传统影像学仅发现6例有转移。传统影像学检测到的几乎所有远处病灶PET/CT都能检测到，且PET/CT还显示另外3例患者有额外的转移部位。2例患者中，PET/CT检测到骨扫描未发现的溶骨性骨转移。5例患者中，PET CT检测到传统影像学漏诊的N3期疾病。共有14例患者进行了第二次PET/CT检查以评估对NACT的反应，11例患者接受了手术。2例患者有完全病理反应。其中1例在第二次PET/CT扫描时有完全代谢及形态学反应，另1例有完全代谢及部分形态学反应。与传统方法相比，18F FDG PET/CT能检测到更多的转移灶以及额外的转移部位。反应评估导致14%的患者治疗方案改变。
