Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine. Assiut University, Assiut, Egypt.
Nucl Med Commun. 2021 Jun 1;42(6):656-664. doi: 10.1097/MNM.0000000000001376.
To evaluate the relationship between semiquantitative and volumetric parameters on 18F-FDG PET/computed tomography (CT), including maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), tumor to liver ratio (TLR) and tumor to mediastinum ratio (TMR) with the level of Ki-67 expression in breast cancer.
We retrospectively reviewed 105 female patients with newly diagnosed breast cancer who underwent baseline 18F-FDG PET/CT and had immunohistochemical staining to determine the level of Ki-67 expression. The following PET parameters were measured (SUVmax, SUVmean, MTV, TLG, TLR and TMR) and correlated with level of Ki-67 expression.
Significant moderate positive correlations were found between the PET parameters (primary SUVmax, SUVmean, TLG, TLR and TMR) and level of Ki-67 expression. The primary SUVmax had the highest correlation coefficient (r = 0.461) followed by TMR (r = 0.455) and P value of <0.001 for both. In ROC analysis, primary SUVmax had the largest area under the curve (0.806, P = 0.0001), with sensitivity of 76.5 % and specificity of 75% for prediction of high Ki-67 level. In univariate analysis, all PET parameters, patient age, tumor grade, molecular subtype, estrogen receptor and progesterone receptor status were significantly associated with Ki-67 level. In multivariate regression analysis, only tumor grade [odds ratio (OR) = 20.460, 95% confidence interval (CI): 11.360-29.559, P = <0.0001], molecular subtype (OR = -21.894, 95% CI: -37.921 to -5.866, P = 0.008), SUVmax (OR = 2.299, 95% CI: 0.703-3.895, P = 0.005) and TLR (OR = -4.908, 95% CI: -9.476 to -0.340, P = 0.035) were found to be the strongest independent predictor factors for the level of Ki-67 expression and hence proliferative activity of malignant cells in breast cancer.
The semiquantitative parameters and volumetric 18F-FDG PET/CT parameter, that is, TLG correlated well with proliferation marker Ki-67 in breast cancer. 18F-FDG PET/CT imaging can be used as a useful noninvasive diagnostic tool in imaging cellular proliferation and hence may substitute for in vitro testing of molecular markers in the diagnoses and staging of breast cancer.
评估 18F-FDG PET/CT 中的半定量和容积参数（包括最大标准化摄取值（SUVmax）、平均标准化摄取值（SUVmean）、代谢肿瘤体积（MTV）、总肿瘤糖酵解（TLG）、肿瘤与肝脏比（TLR）和肿瘤与纵隔比（TMR））与乳腺癌中 Ki-67 表达水平之间的关系。
我们回顾性分析了 105 例新诊断为乳腺癌的女性患者，这些患者在基线时接受了 18F-FDG PET/CT 检查，并进行了免疫组织化学染色以确定 Ki-67 的表达水平。测量了以下 PET 参数（SUVmax、SUVmean、MTV、TLG、TLR 和 TMR）并与 Ki-67 表达水平相关。
发现 PET 参数（原发性 SUVmax、SUVmean、TLG、TLR 和 TMR）与 Ki-67 表达水平之间存在显著中度正相关。原发性 SUVmax 的相关系数最高（r=0.461），P 值均 <0.001。在 ROC 分析中，原发性 SUVmax 的曲线下面积最大（0.806，P=0.0001），用于预测高 Ki-67 水平的灵敏度为 76.5%，特异性为 75%。单因素分析中，所有 PET 参数、患者年龄、肿瘤分级、分子亚型、雌激素受体和孕激素受体状态均与 Ki-67 水平显著相关。多因素回归分析显示，仅肿瘤分级[优势比（OR）=20.460，95%置信区间（CI）：11.360-29.559，P <0.0001]、分子亚型（OR=-21.894，95%CI：-37.921 至-5.866，P=0.008）、SUVmax（OR=2.299，95%CI：0.703-3.895，P=0.005）和 TLR（OR=-4.908，95%CI：-9.476 至-0.340，P=0.035）是 Ki-67 表达水平和乳腺癌恶性细胞增殖活性的最强独立预测因素。
半定量参数和容积 18F-FDG PET/CT 参数，即 TLG，与乳腺癌中的增殖标志物 Ki-67 密切相关。18F-FDG PET/CT 成像可作为一种有用的无创诊断工具，用于成像细胞增殖，因此可能替代体外检测分子标志物在乳腺癌的诊断和分期中的应用。
