Yoo Jang, Kim Bom Sahn, Yoon Hai-Jeon
Department of Nuclear Medicine, Ewha Womans University School of Medicine, Seoul, South Korea.
Sungkyunkwan University School of Medicine, Seoul, South Korea.
Ann Nucl Med. 2018 Jun;32(5):328-336. doi: 10.1007/s12149-018-1251-2. Epub 2018 Mar 19.
We evaluated the significance of breast-specific gamma imaging (BSGI) for determination of upstaging to invasive cancer from preoperative ductal carcinoma in situ (DCIS).
This study enrolled 168 patients with 175 breast lesions diagnosed as DCIS on core-needle biopsy that subsequently underwent preoperative BSGI between September 2011 and October 2017. Both qualitative and quantitative analyses using tumor-to-normal background ratio (TNR) and coefficient of variation (COV) were performed, and the predictive significance for upstaging to invasive cancer was investigated. We also sought to identify clinicopathological factors associated with upstaging and their relation to BSGI findings.
Fifty-eight lesions (33.1%) were confirmed to be invasive breast cancer after the final surgical approach. On univariate analysis, tumor size based on ultrasonography (US), hormone status, histologic grade, Breast Imaging Reporting and Data System category, comedo-necrosis, Ki-67 expression, and BSGI findings were associated with upstaging to invasive cancer. Tumor size > 2.0 cm (p = 0.005), Ki-67 expression > 8% (p < 0.001), qualitative BSGI findings (p = 0.020), and COV > 30.44 (p = 0.022) were independently associated with upstaging after multiple regression analysis.
BSGI is a useful imaging modality for predicting upstaging to invasive breast cancer from DCIS on core-needle biopsy in conjunction with US tumor size and Ki-67 expression.
我们评估了乳腺特异性γ成像（BSGI）对于术前导管原位癌（DCIS）升级为浸润性癌的判定意义。
本研究纳入了168例患者，其175个乳腺病变在粗针活检中被诊断为DCIS，随后于2011年9月至2017年10月接受了术前BSGI检查。进行了使用肿瘤与正常背景比值（TNR）和变异系数（COV）的定性和定量分析，并研究了升级为浸润性癌的预测意义。我们还试图确定与升级相关的临床病理因素及其与BSGI结果的关系。
最终手术方式后，58个病变（33.1%）被确认为浸润性乳腺癌。单因素分析显示，基于超声（US）的肿瘤大小、激素状态、组织学分级、乳腺影像报告和数据系统类别、粉刺样坏死、Ki-67表达以及BSGI结果与升级为浸润性癌相关。多因素回归分析后，肿瘤大小>2.0 cm（p = 0.005）、Ki-67表达>8%（p < 0.001）、定性BSGI结果（p = 0.020）以及COV>30.44（p = 0.022）与升级独立相关。
BSGI是一种有用的成像方式，可结合US肿瘤大小和Ki-67表达预测粗针活检诊断为DCIS的患者升级为浸润性乳腺癌。
