Arslan Esra, Ergül Nurhan, Beyhan Ediz, Erol Fenercioglu Özge, Sahin Rahime, Cin Merve, Battal Havare Semiha, Can Trabulus Fadime Didem, Mermut Özlem, Akbas Sinem, Fikret Çermik Tevfik
Department of Nuclear Medicine.
Department of Pathology.
Nucl Med Commun. 2023 Apr 1;44(4):284-290. doi: 10.1097/MNM.0000000000001663. Epub 2023 Feb 9.
Aim of study is to compare the results of Gallium-68-prostate-specific membrane antigen ( 68 Ga-PSMA) and 18 F-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography(PET)/computed tomography (CT), to evaluate the correlation between PET findings and the level of PSMA, Claudin (Clau) 1, 4, and 7 receptors obtained by immunohistochemical (IHC) analysis, and to determine potential predictive and prognostic values in TNBC.
Forty-seven lesions of 42 subjects diagnosed TNBC both underwent PET/CT scan for preoperative staging/restaging were prospectively included study. PSMA, Clau 1, 4, and 7 expressions were IHC evaluated from the biopsy samples of the primary tumor (PT). Maximum standardized uptake value(SUV max) of the PT, lymph node, and distant organ metastases (DOMs) on 18 F-FDG and 68 Ga-PSMA PET/CT were compared with PSMA, Clau 1, 4, and 7 receptor expressions.
IHC analyses on 29 BC lesions to demonstrate Clau expression showed 86% (25/29) Clau 1, 86% (25/29) Clau 4, 45% (13/29) Clau 7, and 48% (14/29) PSMA-positive. The mean DOM (SUVmax) was 15.5 ± 11.6 for 18 F-FDG and 6.0 ± 2.9 for 68 Ga-PSMA. Axial diameter of BC PT had a significant positive correlation with 18 F-FDG SUVmax, 68 Ga-PSMA SUVmax, and PSMA scores. BC lesions 68 Ga-PSMA SUVmax had a significant negative correlation with the Ki-67 index. Axial diameter of the primary tumor had significant negative correlation with Clau 7 scores ( r = -0.409, P = 0.034). Absence of Clau 1 expression found to significantly increase the rate of DOM (100% vs. 28%) ( P = 0.014). All patients with axillary lymph node (ALN) metastases ( n = 17, 100%) exhibited Clau 4 positivity ( P = 0.021). The presence of PSMA expression observed to significantly increase the rate of ALN metastases (64.7% vs. 25%) ( P = 0.035).
Confirming PSMA expression with PET imaging would be significant as PSMA, a theranostic agent, may be a considerable potential agent for radionuclide treatment strategies, in addition to its additional diagnostic contribution to FDG, especially in patients with metastatic TNBC, which is an aggressive, heterogeneous disease.
本研究旨在比较镓-68-前列腺特异性膜抗原（68Ga-PSMA）和18F-氟脱氧葡萄糖（18F-FDG）正电子发射断层扫描（PET）/计算机断层扫描（CT）的结果，评估PET检查结果与通过免疫组织化学（IHC）分析获得的PSMA、紧密连接蛋白（Clau）1、4和7受体水平之间的相关性，并确定三阴性乳腺癌（TNBC）的潜在预测和预后价值。
前瞻性纳入42例诊断为TNBC的受试者的47个病灶，均接受PET/CT扫描以进行术前分期/再分期。从原发性肿瘤（PT）的活检样本中通过IHC评估PSMA、Clau 1、4和7的表达。比较PT、淋巴结和远处器官转移灶（DOMs）在18F-FDG和68Ga-PSMA PET/CT上的最大标准化摄取值（SUVmax）与PSMA、Clau 1、4和7受体表达。
对29个乳腺癌病灶进行IHC分析以显示Clau表达，结果显示86%（25/29）的Clau 1、86%（25/29）的Clau 4、45%（13/29）的Clau 7和48%（14/29）的PSMA呈阳性。18F-FDG的平均DOM（SUVmax）为15.5±11.6，68Ga-PSMA的为6.0±2.9。乳腺癌PT的轴径与18F-FDG SUVmax、68Ga-PSMA SUVmax和PSMA评分呈显著正相关。乳腺癌病灶的68Ga-PSMA SUVmax与Ki-67指数呈显著负相关。原发性肿瘤的轴径与Clau 7评分呈显著负相关（r = -0.409，P = 0.034）。发现Clau 1表达缺失会显著增加DOM的发生率（100%对28%）（P = 0.014）。所有有腋窝淋巴结（ALN）转移的患者（n = 17，100%）均表现为Clau 4阳性（P = 0.021）。观察到PSMA表达的存在会显著增加ALN转移的发生率（64.7%对25%）（P = 0.035）。
通过PET成像确认PSMA表达具有重要意义，因为PSMA作为一种诊疗试剂，除了对FDG有额外的诊断贡献外，对于放射性核素治疗策略可能是一种具有相当潜力的试剂，尤其是在转移性TNBC患者中，TNBC是一种侵袭性、异质性疾病。
