From the *Department of Radiology, Graduate School of Medicine, Yokohama City University, Yokohama; †Department of Breast and Thyroid Surgery, Yokohama City University Medical Center, Yokohama; Departments of ‡Gastroenterological Surgery, and §Biostatics and Epidemiology, Yokohama City University Graduate School of Medicine, Yokohama; and ∥Department of Breast Surgery, Tokyo Medical University, Tokyo, Japan.
Clin Nucl Med. 2017 Mar;42(3):169-175. doi: 10.1097/RLU.0000000000001497.
The aim of this study was to assess therapeutic response to breast cancer neoadjuvant chemotherapy (NAC) by F-FDG positron emission mammography (PEM) compared with that to whole-body F-FDG PET (WBPET).
Twenty patients underwent WBPET and PEM 3 times: the first time was before NAC, the second time was after 2 courses of NAC, and the third time was after all courses of NAC. A pathological complete response (pCR) was defined as no evidence of residual invasive cancer with or without ductal carcinoma in situ. The relationships between each modality's SUVmax and pathological response were evaluated.
Nine patients achieved a pCR, whereas the other 11 patients had a non-pCR. The SUVmax of WBPET after 2 courses of NAC was significantly lower in the pCR group than in the non-pCR group (1.4 ± 0.4 vs 2.7 ± 2.1, P = 0.0334). There were no significant differences in the SUVmax of PEM (ie, PEM uptake value [PUV]) between the groups. The SUVmax of WBPET (area under the ROC curve [AUC] = 0.761) was superior to the PUVmax (AUC, 0.648) for predicting non-pCR at the interim time point. After all courses of chemotherapy, there were no significant differences between the groups in the SUVmax of WBPET; however, PUVmax was significantly lower in the pCR group than in the non-pCR group (1.0 ± 0.2 vs 2.5 ± 2.7, P = 0.0351). After NAC, the PUVmax (AUC, 0.796) was superior to the SUVmax of WBPET (AUC, 0.671).
There proved to be no apparent superiority of PEM in predicting pCR at the interim time point. Positron emission mammography had greater diagnostic capability for detecting residual cancer after all courses of NAC.
本研究旨在通过 F-FDG 正电子发射乳房摄影术（PEM）评估乳腺癌新辅助化疗（NAC）的治疗反应，并与全身 F-FDG PET（WBPET）进行比较。
20 例患者接受了 3 次 WBPET 和 PEM：第一次是在 NAC 之前，第二次是在 2 个 NAC 疗程后，第三次是在所有 NAC 疗程后。病理完全缓解（pCR）定义为无残留浸润性癌伴或不伴导管原位癌。评估了每种方式的 SUVmax 与病理反应之间的关系。
9 例患者达到 pCR，而其余 11 例患者未达到 pCR。NAC 后 2 个疗程时，pCR 组的 WBPET SUVmax 明显低于非 pCR 组（1.4±0.4 比 2.7±2.1，P=0.0334）。两组之间 PEM 的 SUVmax（即 PEM 摄取值[PUV]）没有显著差异。在中期时间点，WBPET 的 SUVmax（ROC 曲线下面积[AUC]为 0.761）优于 PUVmax（AUC 为 0.648）预测非 pCR。化疗结束后，两组之间 WBPET 的 SUVmax 没有显著差异；然而，pCR 组的 PUVmax 明显低于非 pCR 组（1.0±0.2 比 2.5±2.7，P=0.0351）。NAC 后，PUVmax（AUC 为 0.796）优于 WBPET 的 SUVmax（AUC 为 0.671）。
PEM 在中期时间点预测 pCR 没有明显优势。在所有 NAC 疗程后，正电子发射乳房摄影术具有更大的检测残留癌症的诊断能力。
