Maliha Peter G, Hudson Marie, Abikhzer Gad, Singerman Julia, Probst Stephan
Nuclear Medicine Department, Faculty of Medicine, McGill University.
Division of Rheumatology.
Nucl Med Commun. 2019 Apr;40(4):377-382. doi: 10.1097/MNM.0000000000000981.
To compare the performance of fluorine-18-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) and conventional tests for cancer screening in autoimmune inflammatory myopathy (AIM) patients.
We carried out a retrospective cohort study of AIM patients from one academic center in Montreal, Canada, classified using myositis-specific antibodies, who underwent F-FDG PET/CT between April 2005 and February 2018 and were followed up on average 3.5±2.4 years. Patients were excluded if follow-up was insufficient, AIM diagnosis was indeterminate, and/or malignancy was diagnosed before an F-FDG PET/CT scan. Demographic/clinical data, F-FDG PET/CT results, and available conventional screening tests results were retrieved from electronic and paper medical records.
100 F-FDG PET/CT studies in 63 unique patients [31/63 dermatomyositis (DM), 25/63 overlap myositis, 1/63 inclusion body myositis, 1/63 polymyositis, 1/63 orbital myositis and 4/63 unspecified myositis] were evaluated. Three patients, all classified as DM, were diagnosed with cancer during follow-up with conventional cancer screening tests: breast cancer detected by mammography; squamous cell carcinoma of the skin detected by physical examination; and multiple myeloma detected by blood work. F-FDG PET/CT did not detect any malignancy and led to more additional biopsies than conventional screening (8 vs. 5).
F-FDG PET/CT does not appear to be useful in cancer screening for AIM patients compared with conventional screening and carries potential harms associated with follow-up investigations. The risk of cancer in AIM differs by myositis-specific antibodies-defined subsets and cancer screening is likely to be indicated only in high-risk patients, particularly DM. These results, replicated in larger, multicentered studies, may carry significant consequences for optimal management of AIM and health resource utilization.
比较氟-18-氟脱氧葡萄糖（F-FDG）PET/计算机断层扫描（CT）与传统检查在自身免疫性炎性肌病（AIM）患者癌症筛查中的表现。
我们对加拿大蒙特利尔一个学术中心的AIM患者进行了一项回顾性队列研究，这些患者根据肌炎特异性抗体进行分类，于2005年4月至2018年2月期间接受了F-FDG PET/CT检查，并平均随访3.5±2.4年。如果随访不足、AIM诊断不明确和/或在F-FDG PET/CT扫描前已诊断出恶性肿瘤，则将患者排除。从电子和纸质病历中检索人口统计学/临床数据、F-FDG PET/CT结果以及可用的传统筛查检查结果。
对63例独特患者的100次F-FDG PET/CT检查进行了评估[31/63皮肌炎（DM）、25/63重叠性肌炎、1/63包涵体肌炎、1/63多发性肌炎、1/63眼眶肌炎和4/63未分类肌炎]。3例均被分类为DM的患者在随访期间通过传统癌症筛查检查诊断出癌症：通过乳房X线摄影检测到乳腺癌；通过体格检查检测到皮肤鳞状细胞癌；通过血液检查检测到多发性骨髓瘤。F-FDG PET/CT未检测到任何恶性肿瘤，并且与传统筛查相比导致更多的额外活检（8次对5次）。
与传统筛查相比，F-FDG PET/CT在AIM患者的癌症筛查中似乎没有用处，并且存在与后续调查相关的潜在危害。AIM患者的癌症风险因肌炎特异性抗体定义的亚组而异，癌症筛查可能仅适用于高危患者，特别是DM患者。这些结果在更大规模的多中心研究中得到重复，可能对AIM的最佳管理和卫生资源利用产生重大影响。
