Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Center for Personalized Response Monitoring in Oncology, PREMIO, Odense University Hospital, Odense, Denmark; Center for Innovative Medical Technology, CIMT, Odense University Hospital, Odense, Denmark.
Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Center for Personalized Response Monitoring in Oncology, PREMIO, Odense University Hospital, Odense, Denmark.
Semin Nucl Med. 2022 Sep;52(5):520-530. doi: 10.1053/j.semnuclmed.2022.03.004. Epub 2022 May 4.
Breast cancer prognosis is steadily improving due to early detection of primary cancer in screening programs and revolutionizing treatment development. In the metastatic setting, therapy improvements render breast cancer a chronic disease. Although FDG-PET/CT has emerged as a highly accurate method for staging metastatic breast cancer, there has been no change in response evaluation methods for decades. FDG-PET/CT has proven high prognostic values in patients with metastatic breast cancer when using quantitative PET methods. It has also shown a higher predictive value than conventional CT when applying the respective response evaluation criteria, RECIST and PERCIST. Response categorization using FDG-PET/CT is more sensitive in detecting progressive and regressive disease, while conventional imaging such as CT and bone scintigraphy deem stable disease more often. These findings reflect the higher accuracy of FDG-PET/CT for response evaluation in this patient group. But does the higher accuracy of FDG-PET/CT translate into a patient benefit when implementing it for monitoring response to palliative treatment? We have evidence of survival benefit from a retrospective study indicating the superiority of using FDG-PET/CT compared with conventional imaging for response evaluation in metastatic breast cancer patients. The survival benefit seems to result from earlier detection of progression with FDG-PET/CT than conventional imaging, leading to an earlier change in treatment with potentially better efficacy of the subsequent treatment line. FDG-PET/CT can be used semiquantitatively as suggested in PERCIST. However, we still need to improve clinically applicable methods based on neural network modeling to better integrate the quantitative information in a smart and standardized way, enabling relevant comparability between scans, patients, and institutions. Such innovation is warranted to support imaging specialists in diagnostic response assessment. Prospective multicenter studies analyzing patients' survival, quality of life, societal and patient costs of replacing conventional imaging with FDG-PET/CT are needed before firm conclusions can be drawn on which type of scan to recommend in future clinical guidelines.
由于在筛查计划中早期发现原发性癌症以及治疗方法的革命性发展，乳腺癌的预后正在稳步改善。在转移性疾病中，治疗方法的改进使乳腺癌成为一种慢性病。尽管 FDG-PET/CT 已成为一种高度准确的方法，用于分期转移性乳腺癌，但数十年来，其反应评估方法没有变化。FDG-PET/CT 已通过使用定量 PET 方法，在转移性乳腺癌患者中显示出很高的预后价值。当应用各自的反应评估标准 RECIST 和 PERCIST 时，FDG-PET/CT 也显示出比常规 CT 更高的预测价值。与常规 CT 相比，FDG-PET/CT 用于检测进展性和退行性疾病时的分类更敏感，而常规成像（如 CT 和骨闪烁显像）则更常将其视为稳定疾病。这些发现反映了 FDG-PET/CT 在该患者群体中进行反应评估的更高准确性。但是，在对姑息性治疗的反应进行监测时，FDG-PET/CT 的更高准确性是否会转化为患者受益？我们有一项回顾性研究的证据表明，在转移性乳腺癌患者中，与常规成像相比，使用 FDG-PET/CT 进行反应评估具有生存优势。生存优势似乎源于 FDG-PET/CT 比常规成像更早地检测到进展，从而更早地改变治疗方案，使后续治疗线的疗效可能更好。FDG-PET/CT 可以像 PERCIST 中建议的那样进行半定量评估。然而，我们仍需改进基于神经网络建模的临床适用方法，以便以智能和标准化的方式更好地整合定量信息，使扫描之间、患者之间和机构之间具有相关性和可比性。为了支持影像学专家进行诊断反应评估，这种创新是必要的。在未来的临床指南中，建议使用哪种扫描方法之前，需要进行前瞻性多中心研究，分析患者的生存情况、生活质量、常规成像替代 FDG-PET/CT 的社会和患者成本。
