Takahashi Mizuho, Maeda Hiroyuki, Tsujikawa Tetsuya, Kono Hiroko, Mori Tetsuya, Kiyono Yasushi, Okazawa Hidehiko, Noriki Sakon, Imamura Yoshiaki, Goi Takanori
From the First Department of Surgery, Faculty of Medical Sciences.
Biomedical Imaging Research Center, University of Fukui.
Clin Nucl Med. 2021 Nov 1;46(11):884-889. doi: 10.1097/RLU.0000000000003835.
Estrogen receptor (ER) is expressed in the majority of invasive breast cancer and is an important prognostic indicator. The tumor stroma also plays an important role in disease progression. This study evaluated the effect of stromal components on 16α-[18F]-fluoro-17β-estradiol (18F-FES) uptake in breast cancer and proposed a partial-volume correction method for 18F-FES PET based on histopathological analyses.
Fifteen patients with biopsy-confirmed breast cancer underwent preoperative 18F-FES PET. Estrogen receptor expression in biopsy specimens was assayed by immunohistochemistry, cellular components in surgical specimens were measured using hematoxylin-eosin staining, and nuclear components in surgical and biopsy specimens were measured using Azan-Mallory staining. The relationship between 18F-FES SUV of the primary tumor and histopathological findings including ER expression, the Allred score, ER-positive cellular component ratio, and ER-positive nuclear component ratio (NCR) was examined. The relationship between stroma-free 18F-FES SUV and ER expression was also examined.
18F-FES uptake was not significantly positively correlated with ER expression (r = 0.44, P = 0.10). 18F-FES uptake was significantly correlated with the Allred score, ER-positive cellular component ratio, and ER-positive NCR in surgical specimens (ρ = 0.60, P = 0.02; r = 0.55, P = 0.03; and r = 0.65, P = 0.01, respectively). 18F-FES uptake was predominantly correlated with ER-positive NCR in biopsy specimens (r = 0.84, P < 0.001). Stroma-free 18F-FES SUV was significantly correlated with ER expression (r = 0.78, P < 0.01).
18F-FES PET predominantly demonstrates the level of ER expression in breast cancer cell nucleus. Although tumor 18F-FES uptake is affected by the degree of stromal components, the partial volume effect on the uptake can be corrected by stroma-volume fraction in Azan-Mallory staining.
雌激素受体（ER）在大多数浸润性乳腺癌中表达，是一项重要的预后指标。肿瘤基质在疾病进展中也起着重要作用。本研究评估了基质成分对乳腺癌中16α-[18F]-氟-17β-雌二醇（18F-FES）摄取的影响，并基于组织病理学分析提出了一种18F-FES PET的部分容积校正方法。
15例经活检确诊为乳腺癌的患者在术前接受了18F-FES PET检查。通过免疫组织化学检测活检标本中的雌激素受体表达，使用苏木精-伊红染色测量手术标本中的细胞成分，使用阿赞-马洛里染色测量手术和活检标本中的核成分。研究了原发肿瘤的18F-FES SUV与包括ER表达、奥尔雷德评分、ER阳性细胞成分比例和ER阳性核成分比例（NCR）在内的组织病理学结果之间的关系。还研究了无基质的18F-FES SUV与ER表达之间的关系。
18F-FES摄取与ER表达无显著正相关（r = 0.44，P = 0.10）。18F-FES摄取与手术标本中的奥尔雷德评分、ER阳性细胞成分比例和ER阳性NCR显著相关（分别为ρ = 0.60，P = 0.02；r = 0.55，P = 0.03；r = 0.65，P = 0.01）。在活检标本中，18F-FES摄取主要与ER阳性NCR相关（r = 0.84，P < 0.001）。无基质的18F-FES SUV与ER表达显著相关（r = 0.78，P < 0.01）。
18F-FES PET主要显示乳腺癌细胞核中的ER表达水平。尽管肿瘤18F-FES摄取受基质成分程度的影响，但通过阿赞-马洛里染色中的基质体积分数可校正摄取的部分容积效应。
