Department of Nuclear Medicine, Jinling Hospital, Medical School, Nanjing University, Nanjing, China.
Department of Radiotherapy, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Eur J Nucl Med Mol Imaging. 2022 Jul;49(8):2869-2876. doi: 10.1007/s00259-021-05333-z. Epub 2022 Feb 9.
F-Alfatide II has been translated into clinical use and been proven to have good performance in identifying breast cancer. In this study, we investigated F-Alfatide II for evaluation of axillary lymph nodes (ALN) in breast cancer patients and compared the performance with F-FDG.
A total of 44 female patients with clinically suspected breast cancer were enrolled and underwent F-Alfatide II and F-FDG PET/CT within a week. Tracer uptakes in ALN were evaluated by visual analysis, semi-quantitative analysis with maximum standardized uptake value (SUV), mean standardized uptake value (SUV), and SUV ratio of target/non-target (T/NT).
Among 44 patients, 37 patients were pathologically diagnosed with breast cancer with metastatic (17 cases) or non-metastatic (20 cases) ALN. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of visual analysis were 70.6%, 90%, 81.1%, 85.7%, and 78.3% for F-Alfatide II, 64.7%, 90%, 78.4%, 84.6%, and 75% for F-FDG, respectively. By combining F-Alfatide II and F-FDG, the sensitivity significantly increased to 82.4%, the specificity was 85%, the accuracy increased to 83.8%, the PPV was 82.4%, and the NPV significantly increased to 85.0%. Three cases of luminal B subtype were false negative for both F-Alfatide II and F-FDG. The other 2 false negative cases of F-Alfatide II were triple-negative subtype and 3 false negative cases of F-FDG were luminal B subtype too. The AUCs of three semi-quantitative parameters (SUV, SUV, T/NT) for F-Alfatide II were between 0.8 and 0.9, whereas those for F-FDG were more than 0.9. F-Alfatide II T/NT had the highest Youden index (76.5%), specificity (100%), accuracy (89.2%), and PPV (100%) among these semi-quantitative parameters. F-Alfatide II uptake as well as F-FDG uptake in metastatic axillary lymph nodes (MALN) was significantly higher than that in benign axillary lymph nodes (BALN). Both F-Alfatide II and F-FDG did not show difference in primary tumor uptake irrespective of ALN status.
F-Alfatide II can be used in breast cancer patients to detect metastatic ALN, however, like F-FDG, with high specificity but relatively low sensitivity. The combination of F-Alfatide II and F-FDG can significantly improve sensitivity and NPV. F-Alfatide II T/NT may serve as the most important semi-quantitative parameter to evaluate ALN.
F-Alfatide II 已被翻译并应用于临床，并且已被证明在乳腺癌的诊断中具有良好的性能。本研究旨在探讨 F-Alfatide II 用于评估乳腺癌患者的腋窝淋巴结（ALN），并与 F-FDG 进行比较。
共纳入 44 例临床疑似乳腺癌的女性患者，在一周内接受 F-Alfatide II 和 F-FDG PET/CT 检查。通过视觉分析、最大标准化摄取值（SUV）、平均标准化摄取值（SUV）和靶/非靶（T/NT）比值的半定量分析评估 ALN 的摄取。
在 44 例患者中，37 例患者经病理诊断为乳腺癌，其中 17 例存在转移性（metastatic）ALN，20 例为非转移性（non-metastatic）ALN。F-Alfatide II 的视觉分析的敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）分别为 70.6%、90%、81.1%、85.7%和 78.3%，F-FDG 分别为 64.7%、90%、78.4%、84.6%和 75%。F-Alfatide II 和 F-FDG 联合使用时，敏感性显著提高至 82.4%，特异性为 85%，准确性提高至 83.8%，PPV 为 82.4%，NPV 显著提高至 85.0%。3 例 luminal B 亚型的患者在 F-Alfatide II 和 F-FDG 中均为假阴性。另外 2 例 F-Alfatide II 假阴性的患者为三阴性亚型，3 例 F-FDG 假阴性的患者为 luminal B 亚型。F-Alfatide II 的三种半定量参数（SUV、SUV、T/NT）的 AUC 在 0.8 到 0.9 之间，而 F-FDG 的 AUC 则大于 0.9。F-Alfatide II 的 T/NT 在这些半定量参数中具有最高的约登指数（76.5%）、特异性（100%）、准确性（89.2%）和 PPV（100%）。转移性腋窝淋巴结（MALN）的 F-Alfatide II 摄取以及 F-FDG 摄取明显高于良性腋窝淋巴结（BALN）。无论 ALN 状态如何，F-Alfatide II 和 F-FDG 在原发肿瘤摄取方面均无差异。
F-Alfatide II 可用于乳腺癌患者检测转移性 ALN，但其特异性高，敏感性相对较低。F-Alfatide II 和 F-FDG 的联合使用可显著提高敏感性和 NPV。F-Alfatide II 的 T/NT 可能是评估 ALN 的最重要的半定量参数。
