氟代脱氧葡萄糖正电子发射断层扫描/计算机断层扫描评估转移性乳腺癌患者股骨病理性骨折的风险。
FDG PET/CT Assesses the Risk of Femoral Pathological Fractures in Patients With Metastatic Breast Cancer.
作者信息
Ulaner Gary A, Zindman Alexandra M, Zheng Junting, Kim Tae Won B, Healey John H
机构信息
From the *Department of Radiology, Memorial Sloan Kettering Cancer Center, New York; †Department of Radiology, Weill Cornell Medical College, New York; ‡Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY; §Department of Orthopaedics, Cooper University Hospital, Camden, NJ; ∥Department of Surgery, Memorial Sloan Kettering Cancer Center, New York; and ¶Department of Surgery, Weill Cornell Medical College, New York, NY.
出版信息
Clin Nucl Med. 2017 Apr;42(4):264-270. doi: 10.1097/RLU.0000000000001580.
PURPOSE
Assessment of pathological fracture risk is critical to optimize the use of prophylactic orthopedic fixation to prevent pathological fractures. Better prediction of pathological fracture risk is needed. We evaluated if quantitative measures of FDG avidity can assess femoral pathological fracture risk in patients with metastatic breast cancer (MBC).
PATIENTS AND METHODS
A Health Insurance Portability and Accountability Act-compliant retrospective case-control study was performed under institutional review board waiver. Patients with MBC who received an FDG PET/CT from January 2008 to December 2014 and had pathological fracture of the proximal femur within 3 months of PET/CT were selected as cases. Patients with MBC who had an FDG PET/CT in 2013 were sequentially screened in reverse chronological order to identify patients with proximal femoral metastases on PET/CT but no subsequent pathological fracture to serve as a control group. The prespecified goal was to have twice the number of controls as cases. Target lesions in the proximal femur, from femoral head to 5 cm below the lesser trochanter, were analyzed on FDG PET/CT for SUVmax, SUVmean, metabolic tumor volume, and total lesion glycolysis. Wilcoxon rank sum test was used to compare continuous variables in cases and controls. A nonparametric receiver operating characteristic analysis was performed to assess the ability of quantitative FDG measurements to differentiate between cases and controls.
RESULTS
In 27 cases with pathological fracture and 55 controls without pathological fracture, all 4 quantitative measures of FDG avidity were statistically different between cases and controls (P < 0.001). A total lesion glycolysis of 81 could differentiate between fracture and nonfracture patients with accuracy, sensitivity, and specificity of 0.83, 0.85, and 0.80, respectively.
CONCLUSIONS
Quantitative measures of FDG avidity may help identify breast cancer patients at high risk of subsequent pathological fracture of the proximal femur.
目的
评估病理性骨折风险对于优化预防性骨科固定以预防病理性骨折的使用至关重要。需要更好地预测病理性骨折风险。我们评估了FDG摄取的定量测量是否能评估转移性乳腺癌（MBC）患者的股骨病理性骨折风险。
患者与方法
在机构审查委员会豁免的情况下，进行了一项符合《健康保险流通与责任法案》的回顾性病例对照研究。选取2008年1月至2014年12月接受FDG PET/CT检查且在PET/CT检查后3个月内发生股骨近端病理性骨折的MBC患者作为病例组。对2013年接受FDG PET/CT检查的MBC患者按时间倒序依次进行筛查，以确定PET/CT显示有股骨近端转移但随后未发生病理性骨折的患者作为对照组。预先设定的目标是使对照组的数量为病例组的两倍。在FDG PET/CT上分析股骨近端从股骨头到小转子下方5 cm的靶病变的SUVmax、SUVmean、代谢肿瘤体积和总病变糖酵解。采用Wilcoxon秩和检验比较病例组和对照组的连续变量。进行非参数接受者操作特征分析，以评估FDG定量测量区分病例组和对照组的能力。
结果
在27例发生病理性骨折的病例和55例未发生病理性骨折的对照组中，FDG摄取的所有4项定量测量在病例组和对照组之间均有统计学差异（P < 0.001）。总病变糖酵解为81时，区分骨折和未骨折患者的准确性、敏感性和特异性分别为0.83、0.85和0.80。
结论
FDG摄取的定量测量可能有助于识别随后有股骨近端病理性骨折高风险的乳腺癌患者。
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