Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima City, Hiroshima 734-8551, Japan.
AJR Am J Roentgenol. 2019 Nov;213(5):1129-1135. doi: 10.2214/AJR.19.21373. Epub 2019 Jul 24.
The aim of this study was to assess the diagnostic performance of dual-phase F-FDG PET/CT in detecting axillary lymph node metastasis in patients with breast cancer. A total of 826 patients with breast cancer were retrospectively evaluated. PET/CT scans were performed 1 hour and 2 hours after FDG administration before treatment. The maximum standardized uptake value (SUV) in the axillary lymph node at both time points (hereafter referred to as SUV1 and SUV2, respectively) and the retention index (RI) were calculated. Axillary lymph node metastasis was detected in 285 of 826 patients (34.5%). The median axillary SUV1, SUV2, and RI in patients with nodal metastasis were higher than those in patients without metastasis (1.5 vs 0.6, 1.6 vs 0.5, and 7.7 vs -3.7, respectively; all < 0.001). The diagnostic accuracy of axillary SUV1 and SUV2 was equivalent, and the sensitivity and specificity of SUV1 were 74.7% and 83.4%, respectively. Although the performance of the axillary RI was inferior to that of SUV1 and SUV2, both the SUV and the RI were independent predictors of nodal metastasis, and a positive RI suggested axillary lymph node involvement when the SUV1 was significantly high. Of 533 patients with category T1-2 breast cancer without lymph node swelling, 101 (19.0%) had pathologic lymph node involvement; the negative predictive value of axillary SUV1 was 86.8%. Delayed phase imaging identified axillary lymph node metastasis as accurately as standard PET/CT. A high negative predictive value of PET/CT for the detection of nodal metastasis is helpful to avoid surgical axillary assessment in patients with category T1-2 breast cancer without lymph node swelling.
本研究旨在评估氟代脱氧葡萄糖（FDG）双时相正电子发射断层扫描/计算机断层扫描（PET/CT）在乳腺癌患者腋窝淋巴结转移中的诊断性能。共回顾性评估了 826 例乳腺癌患者。在治疗前，FDG 给药后 1 小时和 2 小时进行 PET/CT 扫描。分别计算两个时间点（以下分别称为 SUV1 和 SUV2）腋窝淋巴结的最大标准化摄取值（SUV）和滞留指数（RI）。826 例患者中，285 例（34.5%）检测到腋窝淋巴结转移。有淋巴结转移患者的腋窝 SUV1、SUV2 和 RI 中位数均高于无转移患者（1.5 比 0.6、1.6 比 0.5 和 7.7 比-3.7；均<0.001）。腋窝 SUV1 和 SUV2 的诊断准确性相当，SUV1 的灵敏度和特异性分别为 74.7%和 83.4%。尽管腋窝 RI 的性能逊于 SUV1 和 SUV2，但 SUV1 和 RI 均为淋巴结转移的独立预测因子，当 SUV1 显著升高时，阳性 RI 提示腋窝淋巴结受累。533 例无腋窝淋巴结肿大的 T1-2 期乳腺癌患者中，101 例（19.0%）有病理淋巴结受累；腋窝 SUV1 的阴性预测值为 86.8%。延迟期成像与标准 PET/CT 一样准确地识别腋窝淋巴结转移。PET/CT 对淋巴结转移检测的高阴性预测值有助于避免无腋窝淋巴结肿大的 T1-2 期乳腺癌患者进行外科腋窝评估。
