Mori Mio, Fujioka Tomoyuki, Katsuta Leona, Tsuchiya Junichi, Kubota Kazunori, Kasahara Mai, Oda Goshi, Nakagawa Tsuyoshi, Onishi Iichiroh, Tateishi Ukihide
Departments of Diagnostic Radiology.
Surgery, Breast Surgery.
Nucl Med Commun. 2019 Sep;40(9):958-964. doi: 10.1097/MNM.0000000000001057.
The aim of this study was to evaluate the performance of preoperative axillary lymph node assessment in breast cancer using time-of-flight 18F-fluorodeoxyglucose PET/computed tomography (TOF [F-18]FDG-PET/CT).
Eighty-two women with breast cancer (mean age, 59.3 years; range, 30-84 years) underwent TOF [F-18]FDG-PET/CT scanning before surgery between January 2016 and June 2018 at our hospital. Visual analysis of FDG uptake and the maximum standardized uptake value (SUVmax) of axillary lymph nodes were compared with the pathological diagnoses.
There were 77 patients with invasive breast carcinoma (mean invasive long diameter, 18.5 mm; range, 2-90 mm) and five patients with noninvasive carcinoma. Axillary lymph node metastases were histologically confirmed in 13 of 82 patients (15.9%). SUVmax showed an area under a receiver operating characteristic curve of 0.916, and the cut-off value of 1.1 was appropriate. By visual assessment, there were 11 true positives, 15 false positives, 54 true negatives and two false negatives; the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 85%, 78%, 42%, 96% and 79%, respectively. SUVmax showed values of 69%, 99%, 90%, 94% and 94%, respectively.
The sensitivity of TOF [F-18]FDG-PET/CT was as high as 85% by visual analysis. SUVmax using TOF [F-18]FDG-PET/CT showed high diagnostic performance for N-staging in breast cancer patients, especially high negative predictive value. The specificity, positive predictive value and accuracy of SUVmax were higher than those of visual analysis.
本研究旨在评估采用飞行时间18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（TOF [F-18]FDG-PET/CT）对乳腺癌进行术前腋窝淋巴结评估的性能。
2016年1月至2018年6月期间，我院82例乳腺癌女性患者（平均年龄59.3岁；范围30 - 84岁）在手术前行TOF [F-18]FDG-PET/CT扫描。将腋窝淋巴结的FDG摄取视觉分析及最大标准化摄取值（SUVmax）与病理诊断结果进行比较。
77例为浸润性乳腺癌患者（平均浸润长径18.5 mm；范围2 - 90 mm），5例为非浸润性癌患者。82例患者中13例（15.9%）经组织学证实有腋窝淋巴结转移。SUVmax的受试者工作特征曲线下面积为0.916，截断值为1.1时较为合适。通过视觉评估，真阳性11例，假阳性15例，真阴性54例，假阴性2例；灵敏度、特异度、阳性预测值、阴性预测值及准确率分别为85%、78%、42%、96%和79%。SUVmax对应的各项指标分别为69%、99%、90%、94%和94%。
通过视觉分析，TOF [F-18]FDG-PET/CT的灵敏度高达85%。采用TOF [F-18]FDG-PET/CT的SUVmax对乳腺癌患者的N分期显示出较高的诊断性能，尤其是较高的阴性预测值。SUVmax的特异度、阳性预测值及准确率高于视觉分析。
