Arslan Esra, Çermik Tevfik F, Trabulus Fadime D C, Talu Esra C K, Başaran Şerife
Departments of Nuclear Medicine.
Surgery.
Nucl Med Commun. 2018 Jul;39(7):680-690. doi: 10.1097/MNM.0000000000000856.
In this study, primary tumors' fluorine-18-fluorodeoxyglucose (F-FDG) uptake in luminal A, luminal B, triple-negative, and human epidermal growth factor receptor type-2 subtypes of breast cancer was evaluated. In addition, the relationship between the primary tumor maximum standardized uptake value (SUVmax) value and the presence of distant metastasis and axillary involvement was evaluated.
Whole-body F-FDG PET/computed tomography (CT) imaging of 493 patients (mean age; 54.6±13.2 years) diagnosed with primary breast cancer were analyzed retrospectively. PET/CT imaging was obtained 60 min after the intravenous administration of F-FDG. F-FDG uptake of the lesions was assessed by calculating the SUVmax. Histopathological analyses were carried out on the basis of biopsy samples before PET/CT. For histopathological staging, the Scarff Bloom Richardson classification system was utilized, and patients were classified into luminal A, luminal B, triple-negative, and human epidermal growth factor receptor type-2 molecular subtypes.
82.9% of the patients had invasive ductal carcinoma, 5.8% had invasive lobular carcinoma, 4.2% had apocrine carcinoma, 3.8% had mucinous carcinoma, and 3.4% has mixed carcinoma. Although the highest mean SUVmax was calculated in apocrine tumors (12.4±7.2), the lowest mean SUVmax was calculated in lobular carcinoma (6.8±4.6), and a statistically significant difference was found between the histological groups (P<0.001). F-FDG uptake was reported to be significantly higher in the triple-negative subtype than the luminal types, and in the luminal B subtype than the luminal A subtype. A statistically significant relation was found between primary tumor SUVmax and distant nodal, organ metastasis (P=0.003 and <0.001, respectively).
Increased primary tumor F-FDG uptake was associated with aggressive molecular subtypes in this study. The relationship of distant nodal and organ metastasis with primary tumor SUVmax showed that increased F-FDG uptake is important in terms of management of therapy and prognosis.
在本研究中，评估了乳腺癌管腔A型、管腔B型、三阴性以及人表皮生长因子受体2型亚型的原发性肿瘤的氟-18-氟脱氧葡萄糖（F-FDG）摄取情况。此外，还评估了原发性肿瘤最大标准化摄取值（SUVmax）与远处转移及腋窝受累情况之间的关系。
对493例（平均年龄54.6±13.2岁）诊断为原发性乳腺癌的患者的全身F-FDG正电子发射断层显像/计算机断层扫描（PET/CT）图像进行回顾性分析。静脉注射F-FDG 60分钟后进行PET/CT成像。通过计算SUVmax评估病变的F-FDG摄取情况。在PET/CT检查前，根据活检样本进行组织病理学分析。对于组织病理学分期，采用斯卡夫-布卢姆-理查森分类系统，将患者分为管腔A型、管腔B型、三阴性和人表皮生长因子受体2型分子亚型。
82.9%的患者患有浸润性导管癌，5.8%患有浸润性小叶癌，4.2%患有大汗腺癌，3.8%患有黏液癌，3.4%患有混合癌。虽然大汗腺肿瘤的平均SUVmax最高（12.4±7.2），但小叶癌的平均SUVmax最低（6.8±4.6），且组织学组间存在统计学显著差异（P<0.001）。据报道，三阴性亚型的F-FDG摄取显著高于管腔型，管腔B型高于管腔A型。原发性肿瘤SUVmax与远处淋巴结、器官转移之间存在统计学显著关系（分别为P=0.003和<0.001）。
在本研究中，原发性肿瘤F-FDG摄取增加与侵袭性分子亚型相关。远处淋巴结和器官转移与原发性肿瘤SUVmax的关系表明，F-FDG摄取增加在治疗管理和预后方面具有重要意义。
