Ming Yue, Wu Nan, Qian Tianyi, Li Xiao, Wan David Q, Li Caiying, Li Yalun, Wu Zhihong, Wang Xiang, Liu Jiaqi, Wu Ning
PET-CT Center, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Front Oncol. 2020 Aug 12;10:1301. doi: 10.3389/fonc.2020.01301. eCollection 2020.
Breast cancer is a major disease with high morbidity and mortality in women worldwide. Increased use of imaging biomarkers has been shown to add more information with clinical utility in the detection and evaluation of breast cancer. To date, numerous studies related to PET-based imaging in breast cancer have been published. Here, we review available studies on the clinical utility of different PET-based molecular imaging methods in breast cancer diagnosis, staging, distant-metastasis detection, therapeutic and prognostic prediction, and evaluation of therapeutic responses. For primary breast cancer, PET/MRI performed similarly to MRI but better than PET/CT. PET/CT and PET/MRI both have higher sensitivity than MRI in the detection of axillary and extra-axillary nodal metastases. For distant metastases, PET/CT has better performance in the detection of lung metastasis, while PET/MRI performs better in the liver and bone. Additionally, PET/CT is superior in terms of monitoring local recurrence. The progress in novel radiotracers and PET radiomics presents opportunities to reclassify tumors by combining their fine anatomical features with molecular characteristics and develop a beneficial pathway from bench to bedside to predict the treatment response and prognosis of breast cancer. However, further investigation is still needed before application of these modalities in clinical practice. In conclusion, PET-based imaging is not suitable for early-stage breast cancer, but it adds value in identifying regional nodal disease and distant metastases as an adjuvant to standard diagnostic imaging. Recent advances in imaging techniques would further widen the comprehensive and convergent applications of PET approaches in the clinical management of breast cancer.
乳腺癌是一种在全球女性中发病率和死亡率都很高的主要疾病。越来越多的影像学生物标志物已被证明在乳腺癌的检测和评估中能提供更多具有临床实用性的信息。迄今为止，已经发表了许多与基于正电子发射断层扫描（PET）的乳腺癌成像相关的研究。在此，我们综述了关于不同基于PET的分子成像方法在乳腺癌诊断、分期、远处转移检测、治疗和预后预测以及治疗反应评估方面临床实用性的现有研究。对于原发性乳腺癌，PET/MRI的表现与MRI相似，但优于PET/CT。在检测腋窝和腋窝外淋巴结转移方面，PET/CT和PET/MRI的敏感性均高于MRI。对于远处转移，PET/CT在检测肺转移方面表现更好，而PET/MRI在肝脏和骨骼转移方面表现更佳。此外，PET/CT在监测局部复发方面更具优势。新型放射性示踪剂和PET放射组学的进展为通过将肿瘤精细的解剖特征与分子特征相结合来重新分类肿瘤提供了机会，并开发出一条从实验室到临床床边的有益途径，以预测乳腺癌的治疗反应和预后。然而，在将这些方法应用于临床实践之前，仍需要进一步研究。总之，基于PET的成像不适用于早期乳腺癌，但作为标准诊断成像的辅助手段，它在识别区域淋巴结疾病和远处转移方面具有附加价值。成像技术的最新进展将进一步拓宽PET方法在乳腺癌临床管理中的综合和融合应用。
