Yoo Jang, Kim Bom Sahn, Chung Jin, Yoon Hai-Jeon
Department of Nuclear Medicine, Ewha Womans University School of Medicine Sungkyunkwan University School of Medicine Department of Radiology, Ewha Womans University, School of Medicine, Seoul, South Korea.
Medicine (Baltimore). 2017 Aug;96(31):e7657. doi: 10.1097/MD.0000000000007657.
We evaluated the prognostic value of quantitative parameters using dual time point (DTP) F-FDG PET/CT (PET/CT) in invasive ductal breast cancer (IDC) with metastatic axillary lymph nodes (ALN) as compared with dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MRI.Seventy patients with IDC and metastatic ALN were retrospectively registered. Static PET parameters including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG) of primary tumor, SUVmax of ALN (SUVALN), and percentage changes (Δ%) in those parameters were measured with DTP PET/CT. From DCE MRI, peak enhancement value, total tumor angio volume, and proportions of kinetic curve types on delayed-phases were investigated. The average apparent diffusion coefficient (ADCavg) was estimated on DWI. To demonstrate the prognostic value of quantitative imaging parameters for recurrence-free survival (RFS), univariate and multivariate analyses were performed using those parameters and clinicohistologic variables.All static PET parameters, %ΔSUVmax, %ΔMTV, and %ΔSUVALN on DTP PET/CT and ADCavg on DWI were significantly predictive for disease recurrence. Of clinicohistologic variables, pathologic tumor (pT) diameter, pathologic ALN stage, tumor grade, and hormonal status also were significantly prognostic. After multivariate analysis, %ΔSUVmax > 25.05 (P = .043), ADCavg ≤ 1016.55 (P = .020), pT diameter > 3 cm (P = .001), and ER negative status (P = .002) were independent prognostic factors for poor outcome.Only %ΔSUVmax of the primary tumor on PET/CT together with ADCavg, pT diameter, and ER status was an independent prognostic factor for predicting relapse in IDC with metastatic ALN. Percentage change of primary tumor on preoperative PET/CT may be a valuable imaging marker for selecting IDC patients that require adjunct treatment to prevent relapse.
我们评估了双时间点（DTP）F-FDG PET/CT定量参数在伴有腋窝淋巴结转移（ALN）的浸润性导管癌（IDC）中的预后价值，并与动态对比增强（DCE）和扩散加权（DW）MRI进行比较。回顾性登记了70例伴有ALN转移的IDC患者。使用DTP PET/CT测量静态PET参数，包括原发肿瘤的最大标准化摄取值（SUVmax）、代谢肿瘤体积（MTV）、总病变糖酵解（TLG）、ALN的SUVmax（SUVALN）以及这些参数的百分比变化（Δ%）。从DCE MRI中，研究峰值增强值、总肿瘤血管体积以及延迟期动力学曲线类型的比例。在DWI上估计平均表观扩散系数（ADCavg）。为了证明定量成像参数对无复发生存（RFS）的预后价值，使用这些参数和临床组织学变量进行单因素和多因素分析。DTP PET/CT上所有静态PET参数、%ΔSUVmax、%ΔMTV和%ΔSUVALN以及DWI上的ADCavg对疾病复发均有显著预测作用。在临床组织学变量中，病理肿瘤（pT）直径、病理ALN分期、肿瘤分级和激素状态也具有显著预后意义。多因素分析后，%ΔSUVmax>25.05（P = 0.043）、ADCavg≤1016.55（P = 0.020）、pT直径>3 cm（P = 0.001）和ER阴性状态（P = 0.002）是预后不良的独立危险因素。PET/CT上原发肿瘤的仅%ΔSUVmax与ADCavg、pT直径和ER状态一起是预测伴有ALN转移的IDC复发的独立预后因素。术前PET/CT上原发肿瘤的百分比变化可能是选择需要辅助治疗以预防复发的IDC患者的有价值成像标志物。
