基于 FDG-PET-CT 的转移性乳腺癌治疗反应的定量评估。
Quantitative Evaluation of Therapeutic Response by FDG-PET-CT in Metastatic Breast Cancer.
机构信息
Service de médecine nucléaire, ICO Nantes , Saint Herblain Cedex , France.
Service de radiologie, CHU Nantes , Nantes , France.
出版信息
Front Med (Lausanne). 2016 May 9;3:19. doi: 10.3389/fmed.2016.00019. eCollection 2016.
PURPOSE
To assess the therapeutic response for metastatic breast cancer with (18)F-FDG position emission tomography (PET), this retrospective study aims to compare the performance of six different metabolic metrics with PERCIST, PERCIST with optimal thresholds, and an image-based parametric approach.
METHODS
Thirty-six metastatic breast cancer patients underwent 128 PET scans and 123 lesions were identified. In a per-lesion and per-patient analysis, the performance of six metrics: maximum standardized uptake value (SUVmax), SUVpeak, standardized added metabolic activity (SAM), SUVmean, metabolic volume (MV), total lesion glycolysis (TLG), and a parametric approach (SULTAN) were determined and compared to the gold standard (defined by clinical assessment and biological and conventional imaging according RECIST 1.1). The evaluation was performed using PERCIST thresholds (for per-patient analysis only) and optimal thresholds (determined by the Youden criterion from the receiver operating characteristic curves).
RESULTS
In the per-lesion analysis, 210 pairs of lesion evolutions were studied. Using the optimal thresholds, SUVmax, SUVpeak, SUVmean, SAM, and TLG were significantly correlated with the gold standard. SUVmax, SUVpeak, and SUVmean reached the best sensitivity (91, 88, and 83%, respectively), specificity (93, 95, and 97%, respectively), and negative predictive value (NPV, 90, 88, and 83%, respectively). For the per--patient analysis, 79 pairs of PET were studied. The optimal thresholds compared to the PERCIST threshold did not improve performance for SUVmax, SUVpeak, and SUVmean. Only SUVmax, SUVpeak, SUVmean, and TLG were correlated with the gold standard. SULTAN also performed equally: 83% sensitivity, 88% specificity, and NPV 86%.
CONCLUSION
This study showed that SUVmax and SUVpeak were the best parameters for PET evaluation of metastatic breast cancer lesions. Parametric imaging is helpful in evaluating serial studies.
目的
利用（18）F-FDG 位置发射断层扫描（PET）评估转移性乳腺癌的治疗反应。本回顾性研究旨在比较 6 种不同代谢指标与 PERCIST、PERCIST 最佳阈值和基于图像的参数方法的性能。
方法
36 例转移性乳腺癌患者接受 128 次 PET 扫描，共发现 123 个病灶。在每个病灶和每个患者的分析中，确定了 6 种指标的性能：最大标准化摄取值（SUVmax）、SUVpeak、标准化附加代谢活性（SAM）、SUVmean、代谢体积（MV）、总病灶糖酵解（TLG）和一种参数方法（SULTAN），并与金标准（根据 RECIST 1.1 定义，由临床评估和生物学及常规成像确定）进行比较。评估仅在 PERCIST 阈值（仅用于每个患者的分析）和最佳阈值（通过接收器操作特征曲线的 Youden 标准确定）下进行。
结果
在病灶分析中，研究了 210 对病灶演变。使用最佳阈值，SUVmax、SUVpeak、SUVmean、SAM 和 TLG 与金标准显著相关。SUVmax、SUVpeak 和 SUVmean 达到最佳的敏感性（分别为 91%、88%和 83%）、特异性（分别为 93%、95%和 97%）和阴性预测值（NPV，分别为 90%、88%和 83%）。对于每个患者的分析，研究了 79 对 PET。与 PERCIST 阈值相比，最佳阈值并不能提高 SUVmax、SUVpeak 和 SUVmean 的性能。只有 SUVmax、SUVpeak、SUVmean 和 TLG 与金标准相关。SULTAN 也表现相同：敏感性为 83%，特异性为 88%，NPV 为 86%。
结论
本研究表明，SUVmax 和 SUVpeak 是评估转移性乳腺癌病灶 PET 的最佳参数。参数成像有助于评估系列研究。
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