Choi Eun Kyoung, Yoo Ie Ryung, Kim Sung Hun, Park Sonya Youngju, O Joo Hyun, Kang Bong Joo
1 Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
2 Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Acta Radiol. 2018 Jan;59(1):41-49. doi: 10.1177/0284185117705011. Epub 2017 Apr 21.
Background Accurate assessment of neoadjuvant chemotherapy (NAC) response with positron emission tomography/computed tomography (PET/CT) or magnetic resonance imaging (MRI) may provide appropriate operation guidelines for individual breast cancer patients. Purpose To compare the values of PET/CT and MRI for response evaluation following NAC in breast cancer patients. Material and Methods Thirty-three consecutive patients who underwent NAC were included. PET/CT and MRI were performed before and one to four weeks after NAC. With response evaluation of PET/CT and MRI, patients with complete/partial responses on imaging studies were considered to be responders, and those showing stable/progressive disease non-responders. Peak standardized uptake value corrected for lean body mass (SULpeak) and metabolic tumor volume (MTV) were measured from PET/CT, and unidimensional diameter (1D) and tumor volume (TV) from MRI. Reduction rates for each parameter were calculated (Δ%SULpeak, Δ%MTV, Δ%1D, and Δ%TV). The pathological response for NAC as reference was evaluated after surgical resection of the remaining tumor in the breast. Results We identified 17 pathological responders and 16 non-responders. PET/CT had lower specificity and accuracy, but higher sensitivity than MRI, although no significant difference was found between PET/CT and MRI. Following NAC, there were significant differences between pathological responders and non-responders in SULpeak ( P < 0.001), MTV ( P < 0.001), 1D ( P = 0.0003), TV ( P = 0.038), Δ%SULpeak ( P = 0.001), Δ%MTV ( P < 0.001), Δ%1D ( P < 0.001), and Δ%TV ( P = 0.001). Conclusion PET/CT showed lower specificity and accuracy than MRI in evaluating responses to NAC, but both PET/CT and MRI parameters may have predictive value in distinguishing therapeutic responders and non-responders following NAC.
利用正电子发射断层扫描/计算机断层扫描（PET/CT）或磁共振成像（MRI）准确评估新辅助化疗（NAC）反应可为个体乳腺癌患者提供合适的手术指导。目的：比较PET/CT和MRI在评估乳腺癌患者NAC后反应中的价值。材料与方法：纳入33例连续接受NAC的患者。在NAC前及NAC后1至4周进行PET/CT和MRI检查。通过PET/CT和MRI的反应评估，影像学检查显示完全/部分缓解的患者被视为反应者，而显示疾病稳定/进展的患者为无反应者。从PET/CT测量瘦体重校正后的峰值标准化摄取值（SULpeak）和代谢肿瘤体积（MTV），从MRI测量一维直径（1D）和肿瘤体积（TV）。计算每个参数的降低率（Δ%SULpeak、Δ%MTV、Δ%1D和Δ%TV）。在手术切除乳房剩余肿瘤后，以NAC的病理反应作为参考进行评估。结果：我们确定了17例病理反应者和16例无反应者。PET/CT的特异性和准确性较低，但敏感性高于MRI，尽管PET/CT和MRI之间未发现显著差异。NAC后，病理反应者和无反应者在SULpeak（P < 0.001）、MTV（P < 0.001）、1D（P = 0.0003）、TV（P = 0.038）、Δ%SULpeak（P = 0.001）、Δ%MTV（P < 0.001）、Δ%1D（P < 0.001）和Δ%TV（P = 0.00）方面存在显著差异。结论：在评估NAC反应方面，PET/CT的特异性和准确性低于MRI，但PET/CT和MRI参数在区分NAC后的治疗反应者和无反应者方面可能都具有预测价值。
