Yilmaz Burcak, Dağ Sedef, Ergul Nurhan, Çermik Tevfik Fikret
Nuclear Medicine Department, Istanbul Training and Research Hospital, University of Health Sciences.
Radiation Oncology Department, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.
Nucl Med Commun. 2019 Nov;40(11):1112-1121. doi: 10.1097/MNM.0000000000001085.
The current study aimed to investigate the diagnostic performance of metabolic parameters of pre-treatment F-18 fluorodeoxyglucose PET/computed tomography for predicting axillary lymph node metastases, distant metastases, and overall survival rates in breast cancer patients.
One hundred thirteen breast cancer patients who underwent pre-treatment F18 [FDG] PET-computed tomography with biopsy-proven axillary lymph node status were included in the current study. In pre-treatment F18 [FDG] PET-computed tomography for primary tumour area maximum standard uptake value, metabolic tumour volume, tumour lesion glycolysis, tumour diameter and for axillary lymph nodes maximum standard uptake value-LN were recorded. Also if distant metastatic sites were observed they were verified.
The median follow-up period was 43.8 months. Five-year overall survival was 98% vs. 56% in patients with tumour diameter < vs. ≥22 mm, 93% vs. 50% in patients with maximum standard uptake value-T < vs. ≥6.7, 71% vs. 70% in patients with metabolic tumour volume < vs. ≥8.31cm, 94% vs. 49% in patients with maximum standard uptake value-LN < vs. ≥1.6, 98% vs. 48% in patients with tumour lesion glycolysis < vs. ≥19 084 g/ml × cm, 90% vs. 30% in patients with negative or positive distant metastases in initial PET/computed tomography, respectively. Maximum standard uptake value-LN with a cut-off level of <1.6 and <5.7 had high sensitivity and specificity for predicting axillary lymph node and systemic metastasis, respectively. Additionally, tumour lesion glycolysis was the strongest independent prognostic factor for overall survival.
Our data shows that the combination of pre-treatment tumour lesion glycolysis and maximum standard uptake value-LN could improve risk stratification among breast cancer patients.
本研究旨在探讨治疗前F-18氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT）的代谢参数对预测乳腺癌患者腋窝淋巴结转移、远处转移及总生存率的诊断效能。
本研究纳入了113例经活检证实腋窝淋巴结状态且接受过治疗前F18[FDG]PET-CT检查的乳腺癌患者。记录治疗前F18[FDG]PET-CT检查中，原发肿瘤区域的最大标准摄取值、代谢肿瘤体积、肿瘤病灶糖酵解、肿瘤直径以及腋窝淋巴结的最大标准摄取值-LN。此外，若观察到远处转移部位，则予以核实。
中位随访期为43.8个月。肿瘤直径<22 mm与≥22 mm的患者，5年总生存率分别为98%和56%；最大标准摄取值-T<6.7与≥6.7的患者，5年总生存率分别为93%和50%；代谢肿瘤体积<8.31 cm与≥8.31 cm的患者，5年总生存率分别为71%和70%；最大标准摄取值-LN<1.6与≥1.6的患者，5年总生存率分别为94%和49%；肿瘤病灶糖酵解<19 084 g/ml×cm与≥19 084 g/ml×cm的患者，5年总生存率分别为98%和48%；初始PET/CT检查时远处转移阴性与阳性的患者，5年总生存率分别为90%和30%。最大标准摄取值-LN的截断值<1.6和<5.7时，分别对预测腋窝淋巴结转移和全身转移具有较高的敏感性和特异性。此外，肿瘤病灶糖酵解是总生存最强的独立预后因素。
我们的数据表明，治疗前肿瘤病灶糖酵解与最大标准摄取值-LN相结合可改善乳腺癌患者的风险分层。
