Kumar Sunil, Vatsa Rakhee, Shukla Jaya, Singh Gurpreet, Bal Amanjit, Mittal Bhagwant Rai
Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Nucl Med. 2022 Jan-Mar;37(1):54-60. doi: 10.4103/ijnm.ijnm_53_21. Epub 2022 Mar 25.
The comparison of angiogenesis imaging (Ga-68-DOTA-Arginine-Glycine-Aspartic Acid [RGD]) positron emission tomography/computed tomography [PET/CT]) with metabolic imaging (F-18 fluorodeoxyglucose [FDG] PET/CT) in primary staging and response assessment to neoadjuvant chemotherapy (NACT) in locally advanced breast cancer (LABC) patients.
In this prospective study, 85 female patients with LABC were subjected to two PET/CT studies (Ga-68-DOTA-RGD and F-18 FDG) within 1 week of each other. Thirty patients had repeat studies 4 weeks after completing eight cycles of NACT. Response assessment was done by RECIST 1.1 criteria.
Ga-68-DOTA-RGD and F-18 FDG uptake in the primary tumor were seen in all patients. Ipsilateral axillary and internal mammary lymph nodes were detected in 77 (90.5%) versus 80 (94.1%) and 22 (25.8%) versus 27 (31.7%) patients on Ga-68-DOTA-RGD and F-18 FDG scans, respectively. Ipsilateral supra-clavicular lymph nodes and skeletal lesions were noted in 17 (20%) versus 21 (24.7%) patients and 23 (27.0%) versus 24 (28.2%) patients on Ga-68-DOTA-RGD versus F-18 FDG studies, respectively. However, the Ga-68-DOTA-RGD did not show uptake in F-18 FDG avid liver lesions (LLs) in 10 patients, adrenal lesion in one patient, mediastinal lymph nodes in 2 patients, lung nodules, and pleural soft-tissue deposits, each in one patient. In response assessment, 23 and 25 patients had concordance with RECIST1.1 criteria on F-18 FDG and Ga-68-DOTA-RGD scans, respectively. However, there were discordant results in four patients on Ga-68-DOTA-RGD scan and two patients on F-18 FDG scans.
Metabolic imaging is better in primary staging and chemotherapy response assessment than angiogenesis imaging in LABC patients. The latter may miss the metastatic soft-tissue deposits, adrenal, and LLs.
比较血管生成成像（镓-68-四氮杂环十二烷四乙酸-精氨酸-甘氨酸-天冬氨酸[RGD]正电子发射断层扫描/计算机断层扫描[PET/CT]）与代谢成像（氟-18氟脱氧葡萄糖[FDG]PET/CT）在局部晚期乳腺癌（LABC）患者新辅助化疗（NACT）的初始分期及疗效评估中的应用。
在这项前瞻性研究中，85例LABC女性患者在1周内接受了两次PET/CT检查（镓-68-四氮杂环十二烷四乙酸-RGD和氟-18 FDG）。30例患者在完成8个周期的NACT后4周进行了重复检查。疗效评估采用RECIST 1.1标准。
所有患者的原发肿瘤均可见镓-68-四氮杂环十二烷四乙酸-RGD和氟-18 FDG摄取。镓-68-四氮杂环十二烷四乙酸-RGD和氟-18 FDG扫描分别在77例（90.5%）对80例（94.1%）患者以及22例（25.8%）对27例（31.7%）患者中检测到同侧腋窝和内乳淋巴结。镓-68-四氮杂环十二烷四乙酸-RGD和氟-18 FDG研究分别在17例（20%）对21例（24.7%）患者以及23例（27.0%）对24例（28.2%）患者中发现同侧锁骨上淋巴结和骨骼病变。然而，镓-68-四氮杂环十二烷四乙酸-RGD在10例患者的氟-18 FDG摄取活跃的肝脏病变（LLs）、1例患者的肾上腺病变、2例患者的纵隔淋巴结、1例患者的肺结节以及1例患者的胸膜软组织沉积物中均未显示摄取。在疗效评估中，氟-18 FDG和镓-68-四氮杂环十二烷四乙酸-RGD扫描分别有23例和25例患者符合RECIST1.1标准。然而，镓-68-四氮杂环十二烷四乙酸-RGD扫描有4例患者以及氟-18 FDG扫描有2例患者出现了不一致的结果。
在LABC患者中，代谢成像在初始分期和化疗疗效评估方面优于血管生成成像。后者可能会遗漏转移性软组织沉积物、肾上腺和LLs。
